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ART. XII. A Treatise on Scrofula. By James Russell, Fellow of the Royal College of Surgeons, and Professor of Clinical Surgery in the University of Edinburgh. 8vo. 58. Sewed. Constable and Co., Edinburgh; Murray, London.
NY circumstances connected with the author of this volume concurred to raise our expectations respecting it. He has, for a series of years, enjoyed a situation which affords him every opportunity of gaining information on the subject which he treats; he possesses a high character for industry in the collection of facts, and correctness in the investigation of them; and he has the credit of uniting a considerable portion of literary acquirement with his professional skill. In a treatise on Scrofula proceeding from his pen, therefore, we thought it was not unreasonable to look for a full account of the phænomena of this malady in all its principal varieties, and for an accurate diagnosis between it and those diseases which most nearly resemble it. We supposed also that he would give us a general view of the controverted points which regard the history and treatment of Scrofula; and that the cure, both of the constitutional and of the local affections, would have been discussed in the most ample manner. How far these expectations have been fulfilled, it now remains for us to inform our readers.
After a few observations on the hereditary nature of scrofula,' in which the author deems it necessary to inform us that it is not the disease itself which is born with the patient, but only a greater aptitude to receive certain morbid impressions which may bring the latent disposition into action, he proceeds to detail the symptoms and appearance' of this complaint. He begins with a general description of the scrofulous constitution, as indicated by the fairness of the complexion, the lightness of the hair, the floridness of the cheeks, &c. The peculiarity of this constitution is also noticed as to its sensibility to external impressions, and the quickness with which it passes from the extremes of health; circumstances which are attributed to a great laxity of the solids,' a phrase that is common in the language of the schools, but to which we feel it difficult to attach any precise meaning. The scrofulous constitution is supposed likewise to depend on, or to be connected with, a smaller proportion of red blood in the sanguiferous vessels; a fact which seems not easily reconcilable with the floridness which is pointed out as one of its most obvious characteristics. Mr. Russell controverts the doctrine that scrofula depends entirely on a morbid affection of the lymphatic system, because parts not possessed of the glandular structure are often the primitive seat of the disease; such as the joints, the bones,
and the mucous membranes. The local affections which attend scrofula are said to be particularly remarkable for their indolent nature; while, at the same time, they have a tendency to produce a considerable enlargement of the parts which they attack. We have then a description of the nature of scrofulous tumors, as consisting of a peculiar fluid, contained in a cyst; and Mr. R. mentions the changes which the fluid undergoes, and the manner in which the cyst is formed, by the condensation of cellular membranes. With a few remarks on the disease when it attacks the bones, and on the appearance of scrofulous abscesses, the chapter concludes.
We apprehend that most of our readers will feel, as we did, very considerable disappointment from this part of the work. Regarding it as an account either of the scrofulous constitution, or of the local affections produced by this habit, we think that it is extremely imperfect: in neither case is the object brought clearly into view; and the two are so intermixed and confounded, as to leave nothing in our minds but the sensation of a perpetual attempt to grasp at something which we are never able to reach. Besides this general defect of confusion and vagueness in his descriptions, the author occasionally falls into direct contradictions: for example, he informs us that the slow progress and indolent nature of local scrofulous affections constitute their most prominent characteristics; yet we are afterward told that they are sometimes unusually rapid in their formation. These statements may be both true, and the apparent inconsistency may perhaps be reconciled: but, in order that this should be the case, it would be necessary to begin by establishing the constitutional and local symptoms of the disease with much more precision than Mr. Russell has manifested. We have no hesitation in asserting that the medical student, who should peruse this chapter with the expectation of learning from it what scrofula is, would close it without having gained his object.
The succeeding chapters, on the prognosis,' and on the proximate cause and nature of scrofula,' are liable to the same kind of objection with the preceding; though, perhaps, they may be less open to animadversion, from the obscurity which unavoidably attaches to the investigation. The author's opinion respecting the sedative nature of scrofula we are not altogether capable of comprehending: he informs us that, in some cases of sudden death, the heart has been found enlarged, pale, and flaccid; and he says that this state of appearances after death corresponds exceedingly well with the symptoms during life.' Is it here meant that this condition of the heart is itself the primary cause of the scrofulous constitution, or
that the organ is secondarily affected with the local symptoms of the disease, and thus produces, as it were, an accidental cause of death? Whatever be the hypothesis that Mr. Russell intends to support, we doubt much whether the state of the heart can be considered either as throwing any light on the nature of the disease, or as corresponding with the immediate symptoms. The scrofulous constitution, we are informed, is denoted by activity and 'alertness; and we learn that the prominent symptom of the latter stages of the actual disease is a quick pulse, connected with the hectic fever: but we should not imagine that either of these conditions could immediately depend on a relaxed state of the muscular fibres of the heart. Besides, it is well known that sudden death is not by any means a frequent occurrence in scrofula, but that, on the contrary, life seems to be gradually worn out by the complete exhaustion of all its powers: when sudden death takes place, we are led to regard it as something out of the common course of the disease; and we must therefore consider any unusual appearance which the heart may present, not as the cause of death in this particular case, but as a circumstance totally unconnected with scrofula. We are better pleased with the author's remarks on the occasional causes; and we are the more inclined to point them out to the notice of the reader, because we are convinced that it is by a steady and well-regulated attention to these points that the disease is principally to be combated. The effects of a moist and changeable climate appear to be the grand sources of mischief, which it should be our constant endeavour to counteract. They are greatly aggravated by impure air, insufficient nutriment, and in short by all those circumstances which tend to impair the general strength of the system.
In the chapter which treats of the method of cure, although it gives but a very imperfect view of the subject, and such as we should not have expected from the pen of Mr. Russell, we are supplied with some useful observations. The treatment of the disease obviously divides itself into two heads, the constitutional and the local management. The first is the most important, because, without an attention to this point, all local applications must be in a great measure inefficacious; and with respect to it the author justly observes that we must look for benefit rather from a proper regulation of the habits of life, than from the administration of any specific medicine. - We shall quote the remarks on the subject of diet:
Of the various articles of regimen which demand attention in the management of scrofulous patients, the article of diet is one of the most important. The languor and debility which prevails in scrofula
naturally indicates the use of simple nutritious digestible food, taken in such quantity as the stomach can bear, without being overloaded. Nutritious diet is supposed to include a reasonable allowance of animal food. A violent prejudice, it is true, formerly prevailed in favour of a contrary system of management. But experience, and more accurate observation, has now fully confirmed the pernicious effects of that over abstemious system, and has deservedly brought it into discredit. I have no doubt on the subject myself; and so far as it is allowable to argue from a single instance, I may refer to a case, in which the question was brought to the test of experiment. The elder children in a gentleman's family were reared agreeably to the precepts of the abstemious system, and became scrofulous at an carly period of life. This distressing occurrence occasioned great vexation and alarm; and the parents being people of good sense, determined to alter the system of management, and to try the effects of a fuller and more nourishing diet. The younger children, therefore, were all teared according to the opposite system, and, being indulged in a more liberal allowance of food had the good fortune to escape any appearance of scrofula. It is impossible to conceive a case, in which the circumstances of the patients on whom the experiment was made could be more exactly alike.'
To Mr. Russell's recommendation of a nutritious diet in scrofula, we fully subscribe; and it is a doctrine which is now pretty generally diffused among the more intelligent part of the profession: but we believe that the former mischievous opinion is still by no means eradicated from the minds of the inferior orders.
Another point, which we think is deserving of serious attention, is the author's prescription of the warm bath his reasoning is plausible; and his authority cannot but have great weight in a practical question of this nature. With respect to the other remedies, purging is favourably mentioned, the sulphureous waters are deemed useful, and calomel is given in alterative doses. Mr. R. places no confidence in any of the pretended specifics for scrofula, and particularly joins his experience with that of Mr. Thomson of Edinburgh against the muriate of lime. His remarks on the management of local scrofulous affections we cannot much applaud; since we apprehend that they would afford but little information to a student, and must appear very unsatisfactory to the more advanced practitioner. It is a circumstance of surprize to us that Mr. R. should not have been able to produce something of more value from the numerous records of his practice.
When we arrive nearly at the end of the work, the author observes, it may possibly have been expected that I should consider the scrofulous affections of the different organs of the body.' Such certainly was our expectation; and we think that, without descending to these particulars, the work must be re
garded as answering in a very imperfect manner to its title. His apology that such an undertaking would have been very extensive, and that it would have required him to give a description of the different parts, first in their sound and afterward in their morbid state, is totally irrelevant. The subject unquestionably is very extensive, but it is also of great importance; and a well-digested treatise respecting it is much wanted. Before we perused this volume, we were disposed to regard Mr. Russell as peculiarly well qualified for that task: but we confess that our opinion is altered, and that we contemplate with no great complacency a kind of promise that he will, in some future work, supply the deficiencies of the present.
In concluding, we must remark concerning Mr. Russell's style, that, although it possesses something of a classical air, and may, on a superficial examination, be said to be elegant, yet we cannot on the whole recommend it. Besides being marked by Scotticisms and errors in concord, it is frequently verbose, and the different members of the sentences are so involved that the meaning is completely lost under a cloud of words. A part, however, of this defect attaches more to the ideas than to the mere composition; for we are persuaded that, on some occasions, Mr. Russell has indulged himself in constructing flowing periods and magnificent phrases, without having completely made up his mind respecting the meaning of them.
For SEPTEMBER, 1810.
Art. 13. A Tribute to the Memory of William Cowper, Author of the Task, and other Poems, occasioned by the Perusal of his Works and Hayley's Memoirs of his Life. By I. T. S. 8vo. PP. 34. Longman and Co.
To the virtues and to the muse of the amiable and pathetic Cowper, a tribute is here paid in verse of no ordinary merit, though occasionally a false quantity occurs. Mr. I. T. S. seems to catch a
spark of the genius which he celebrates; and which
with pow'rs sublime
Bath'd Sharon's roses with Pierian dews.' |
By the following extract the reader will perceive that the author's blank verse is flowing; and that, while he enters with modesty on his undertaking, he is not likely to disappoint in the execution :
O form'd by nature, as by virtue form'd
To polish, to instruct, improve thy age: