OF IPATITRE AND At IN THE CUBE OF DISEASE. ° Di
this work Sir John Forbes gives the profession and the public the result of fifty years' experience in the medical art; arriving at the conclusion that there is nothing like Nature. In fact, the object of the writer is to dispossess the public mind of the magical notions that, he conceives, even the well-educated associate with medical practice, and the exalted ideas of the power of their art still entertained by young medical men, and practitioners of mature age who were trained in the " active " school of thirty or forty years ago, and whose prepossessions override their lifelong experience. To effect his object, Sir John Forbes takes a survey of the causes, modes of production, and nature of diseases, as well as of their course and natural termination, besidesadducing evidence of the possibility of natural cures without any aid from art. This introductory exposition is followed by a summary review of the different classes of diseases, arranged under two principal heads : complaints which yield (if they yield at all) to specific medicines—as ague to what is popularly called bark ; disorders which must be influenced more indirectly by an action or supposed action producing changes in the system—for the author conceives that many drugs have not the effects ascribed to them. Although Sir John thinks that diseases which are curable are for the most part curable by Nature alone, without any aid from art, yet he does not deny the benefits which art can render, especially in chronic disease, by quickening the cure, by relieving painful symptoms, by mitigating what is not curable, and in some cases by preserving life itself. What he really contends for is, that the medical man should consider himself the minister of Nature, and not, as he too often fancies himself, the master. Practice grounded on this principle would not aim at " cutting short" a complaint by the most violent remedies; for although such a course may sometimes apparently succeed, it more generally falls; while its success leaves behind it a convalescence almost as tedious as the disease would have been, possibly a ruined constitution. What is called " active " practice is less violent than the "cutting short" system; but it proceeds, our author thinks, upon a wrong principle, setting up a violent disturbance in the system on the chance of something coming of it. The system Sir John himself advocates is as follows.
"1st, To place the diseased body in the most favourable circumstances for the development and exercise of its own conservative powers, by the institution of a proper regimen, in the most comprehensive sense of that term. 20, To endeavour thereby, or through the use of medicaments, to remove such obstacles to the favourable action of the conservative and restorative powers as may be removeable without the risk of checking or injuriously perverting them. 3d, Applying these measures under a watchful supervision ; not to attempt, by any vigorous measures, to alter the course of the morbid processes so long as they seem to keep within the limit of safety; and when they transgress or threaten to transgress this limit, only then to endeavour to modify them by such mild measures as, if they fail in doing good, cannot do much harm. 4th, To be on the watch against possible contingencies, which may demand the employment of measures of exceptional activity, whether in the form of regimen or medicine ; and, when required, to apply such measures with the necessary vigour. This last indication refers to such contingencies as great irritation or pain, exhaustion, sleeplessness, diarrhcea, vomiting, intereurrent local inflammations, &e., which often adnut, of great mitigation at least, if not of complete removal, by drugs, dietetic stimulants, cte.
"This form of practice, while based essentially on the two great facts of the great power of Nature to cure acute diseases, and the comparatively small power of art to aid her in this work, much less to take her place, is far from ignoring the existence or value of the medical art, but merely seeks to take advantage of all the good while endeavouring to eschew much of the evil it is capable of effecting when misdirected or misemployed."
To this mode of practice there seems no valid objection; and but that the author's knowledge must be much greater than ours, * Of Mature and Art in the Cure of Disease. By Sir John Forbes, M.D., &e.; Physician to the Queen's Household, Be. Published by Churchill. we should have thought that some such system as above indicated was growing into fashion. The simple practice in France, and on the Continent generally, could not but contrast with the active practice in full vogue here some forty years ago. Homoeopathy, if it did nothing else, gave a blow to the revulsion system, with its copious blood-letting, its enormous doses of calomel, and other strong medicines. We think the general tendency of writers of late years has rather verged to the " expectant " system of Sir John Forbes. As long ago as 1842, Dr. Gully published his Simple Treatntent,t in which the practice recommended was even milder thou our author's programme, except in violent attacks of the brain or the lungs, when future mischief to the constitution must be risked to save life. At the same time, this mild plan of practice, though theoretically or even professionally fashionable, is not as yet likely to be 'popular, at least if the patients know how they are being treat. The mass of men would rather take their chance with strong doses for a few days, than keep quiet for a week or two on barley-water and mild doses. If the patients themselves were satisfied, " friends " would be crying out for "something to be done." Of this difficulty, indeed, Dr. Forbes seems to be fully aware, and one end of his book is to dissipate the delusive expectations of the public in general as to what medical treatment can really effect; though, if people knew better, the probability is that numbers would still like a practitioner who quickly" gets them well." This popular aim of the author has probably given a character of verboseness to his book, as if he were diluting his views and arguments for the general reader. We agree with his general conclusions as to the curative powers of Nature the limited powers of art in the most favourable cases, its utter helplessness in. the worst, and the system of practice he deduces therefrom ; but we doubt whether his arguments will carry a very strong conviction to a medical mind opposed to his views, or to a person whose ideas upon the subject are altogether unformed.
+ Spectator for 1842, page 839.
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