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nell, or Lord Glenelg for Mr. M'Kensie: position to conservative—that is, to conbut, like Shakspeare's wretched apothe- stitutional feelings. The total failure of cary, it was their poverty rather than all the political changes miscalled retheir will which reduced them to deal in forms, either to accomplish their own these poisonous combinations.

promised objects, or to better in any deBut they have gone so far that, for gree the social condition of the peoplethem, there is no extrication—they are at the flagrant insincerity of professing paa dead lock; of victory over the Conser- triots—the awful and exemplary lessons vatives there is no hope ; of retreat from so widely inflicted by the recent riots and the Radicals there is no possibility. The rebellions, and, in short, the tardy wisdom, more respectable members of their party, which even the least cultivated intellects or rather of what was their party, exhibit must gather from a series of unsuccessful increasing uneasiness and dissatisfaction. experiments, will, we trust, have their Some of them are already dropping off; due effect on the popular mind, and disand we can have no doubt that but for the pose that portion of it which has been the foolish and unconstitutional engagements most disturbed, be willing to return to with the Court in which they have involv- a state of constitutional order. It is only ed themselves, every man who has any in such a state that industry—the real and share of talents or character amongst only permanent wealth of the masses of them would be glad to get safely out of a mankind---can develope itself and produce boat which they feel is rapidly approach- the fruits of public prosperity, by the ining the falls ! Lord John Russell can dividual ease, comfort, and happiness of have no desire to face a motion for Eng. the laborious classes. They, after all, lish inquiry similar to that which Lord must raise and earn the bread they are Roden carried last session for Ireland. to eat, and never can do so plentifully,

But whatever becomes of them, the cheaply, and constantly, except under the gigantic engines of turbulence and de- shelter of public tranquillity. As the promoralization which their original indis- ducts of nature are deteriorated, dimicretion set in motion, and which their nished, or even destroyed by unseasonasubsequent weakness has rendered so for- ble vicissitudes and inclemencies of weamidable, will remain, we fear, for a time ther, by floods and by storms,-so the at least, in full activity, and will impose working classes will find - we believe, inon whoever is to succeed to the manage- deed, that to a vast extent they are alment of affairs a task-not, we trust in ready convinced—that the necessaries, divine Providence, wholly impracticable, comforts, and enjoyments of their existbut one of the most awful difficulty ; one ence are rendered scanty and precarious which undoubtedly can have no chance by discontent, agitation, and disorderof success, but by the happiest combina- which are the blights, floods, and temtion of vigour and discretion-the sober- pests of the social and political world. est, and, at the same time, the highest • Order,' says the philosophic poet, is views, and the most indefatigable pa. Heaven's first law; and the apparently tience, united with the most intrepid firm- accidental distinctions of birth, rank, or ness, in those who are to govern; but riches, like the not more natural differeven all this will not suffice without the ences of strength, stature, or talents, are most disinterested indulgence—the most inseparable parts of the general design of generous confidence and the most zealous Providence, which the turbulence of man co-operation, and, we may say, partner- may for a moment disarrange, but which ship, in their labours and responsibilities, he never can permanently destroy. on the part of every man who has any We cannot better conclude these ob. spark of true patriotism, or any regard servations than with the same poet's for the ancient institutions and constitu- beautiful adaptation of the whole system tion of his country.

of the universe to the social state of There is one strong gleam of hope- man:not naturally a bright one, but cheering Such is the World's great Harmony—that springa in the surrounding darkness. It is the Froun Order, Union, full Consent of things : intrinsic misfortune of popular constitu- Where small and great—where weak and mighty~ encies, to be easily led astray: it is a To serve, not suffer-strengthen, not invade ; compensating advantage that they are More powerful each as needful to the rest, also susceptible of being, though certain. And in proportion as it blesses, blest ; ly not so easily, reclaimed to the right Draw to one point and to one centre bring way; and already we can see amongst For forms of government let fools contest,

Beast, man, or angel-servant, lord or king, the more numerous classes a strong dis. That which is best administerd is best.'

THE

LONDON QUARTERLY REVIEW,

No. CXXX.

FOR MARCH, 1840.

Art. I.-Medical Notes and Reflections., out of view the tedious apparatus of mi

By Henry Holland, M.D., F.R.S., Phy- nute facts, from which he has deduced sician Extraordinary to the Queen, &c. the principles with which his work is fill&c. London. 8vo. 1839.

ed; and this, perhaps, constitutes no

small part of its worth ; for while the ex. This book is one of a class extremely amples quoted are salient, and to the puzzling to us reviewers. It is, in fact, a point, all that a well-educated physician collection of thirty-five reviewals, many may be supposed to know is not ostentaof them capital ones, upon as many top- tiously dragged forth. So far the volume ics, almost all of them exceedingly im- is strictly addressed to the profession ; portant and interesting. Such chapters, but the subjects discussed are in many bein lready the summaries of subjects, instances such as appeal to the curiosity are found to trench on our craft, render- of all intelligent persons; and, for the ing an analysis of the essence of an es- most part, merely technical phraseology sence not unlikely to end in the conver- has been abstained from. For the reader sion of substantial fact and vigorous réa- who delights to fathom the 'mare mag. soning into thin and airy speculation. num' of metaphysics there is scope enough

The accomplished author informs us in the essays On Time as an Element of that he has been accustomed, during Thought in mental Functions,'— On the twenty years of practice in London, to Nervous System,'— On Phrenology,'preserve not merely memoranda of parti-On Sleep,'— On Dreaming, Insanity, and cular cases, but also of such general re- Intoxication,'—' On the brain as a double flections as were suggested to him by Organ,'— On the Effects of mental Atactual observation. Twenty years is in- tention on bodily organs. The valetudideed a large portion of that span of ex- narian, or the medical dilettante, may see, istence over which we all are hastening; in the chapter 'On the Abuse of Purgabut twenty years of sight and insight ex- tive Medicines,' some of the risks he pended on society, in all its multifarious runs; or he may fortify his privilege of working, as exhibited in this huge metro- hampering his doctor by adding to the polis, is a privilege of which few can judicious enumeration of the essay On boast ;-and woe to him who, possessing Points where a Patient may judge for so precious a talent, shall have let the himself,' all the points where he ought winged hours speed away, leaving no not. Much curious information he may permanent fruits of benefit for mankind! cull from the discussion ‘On the Influence

Dr. Holland appears to have so con- of Weather in relation to Disease. Both ducted his methods of inquiry as to keep patients and physicians will find an abun

23

VOL. LXV.

dant supply of material for thought in son or remedy where there is largest profession of the masterly chapter on Gout. Scarcely relief, less excellent are those entitled 'Bleed

* All these things, familiar in practice in this ing in Affections of the Brain,'— The Con- physician in cases of dyspepsia hardly less difficult

country, make the situation and conduct of the nection of certain Diseases,'— The Use than in acute and dangerous diseases. Though the of Opiates,'—' Of Diluents,'-Of Emet- symptoms before him are not so critical in kind, ics. Such is the variety of subjects han- they need sound moral management, as well as dis

creet methods of medical treatment. Forbearance dled with more or less of detail, that few and firmness are both required ; and, together with readers, professional or non-professional, these, integrity and good faith. The admirable can fail to be arrested by trains of obser- precepts as to uprightness in practice, which came vation and reflection which they will be obtain here their closest application ; and may well

down to us under the great name of Hippocrates, happy to pursue under the guidance of so be impressed upon all who are entering on a medifull and able a master as Dr. Holland. cal life. The mind must be fashioned early and Throughout, we may add, they will find strongly in these professional principles, as they are a high tone of moral sentiment, worthy rarely attained afterwards, and even with difficulty of his noble profession-a generous con- the conduct of the physician.'—pp. 340, 341.

preserved, amidst the many difficulties which beset tempt of all mean practices and compliances—the dignity of a philosopher com

The father of dyspeptic medicine is bined with the graceful illustration and undoubtedly John Abernethy; for, prior extensive sympathy of a scholar and gen- constitutional, that is, general treatment,

to his time, the cure of local disease by tleman.

Not wishing to mock our readers with was either little understood or little rea catalogue raisonné of so many multifa- garded. He professed, however, to derious essays, we select for examination

rive all his principles from his master and that entitled" Diet and Disorders of Di- idol, the great John Hunter. The singugestion,'-the rather because many of the bringing to light all the treasures

which

lar felicity possessed by the pupil, of topics, to which the author has allotted a separate head of discussion, readily find lay hidden in the obscure depths of such a place under the one we have chosen.

an intellect as that of his early instructor, There are few faculties of body or mind

soon rendered the system of dyspeptic on which the influence of the nutritive

medicine so popular, as to put aside al. process is not marked and incessant.

most every other mode of medical invesWe are well pleased to quote in the tigation. The principles which Aberoutset such a passage as the following:- nethy brought into vogue were so simple,

The habits of society among the higher classes, them; they were so universal, as to be and the influence of dyspeptic complaints on the shut out, in their application, from no mind, render the treatment of such disorders a mat. disease, whether mental or corporeal, heter of great interest, even in a moral point of view. reditary or accidental. And lastly, they worst parts of medical practice find their readiest were enforced by a sum of personal quadisplay. Fraud, intrepid in its ignorance, here wins lities which carried away all who had the an easy triumph. Seconded on every side by pre. happiness of hearing this most original judices, fashions, and foibles, and taking advantage of lecturers. He awakened attention by of the mind and body in their weakest mood, it deals the flow and breadth of the richest Doric, out precepts and drugs with a pernicious facility; sometimes altogether at random ; sometimes, and and he fixed it not more by the intrinsic even more injuriously, with one common scheme of worth of his statement than by his very treatment applied to the most variable and incon. uncommon dramatic and mimetic powers. gruous symptoms. • These abuses indeed, in their worst form, exist

His illustrations were never trivial ; often only on the outskirts of the profession. But it will profound, yet without ostentation or be admitted by all who have candour and cxperi- mysticism. The anecdotes with which ence, that there is no part of medical practice where his lectures abound (he almost always knowledge and good faith are put to equal trial as educed his principles from examples) the effect of the disorder in obscuring the judgment, were usually not only very appropriate and rendering impotent the will of the patient, be but exceedingly picturesque, for he was comes an embarrassment to the physician. If his a great master of the art of 'word-paintof aid ; if hasty and rash, of that control from the ing. They teemed with knowledge of opinion of his patient which is frequently needful. the heart; so that besides the point of The mind of the dyspeptic uncertain and fickle. scientific interest which was prominently He interprets falsely his own sensations, and the ef. set forth, there was a large margin for at one moment and under a new remedy; at another thought in his comments on human chatime as irrationally desponding; prono, moreover, to racter and opinions, as seen in action or change his medical adviser, and to resort to any per- I recorded in books; to three or four of

which, and those of the highest order, they made practical medicine dependent he confined his reading. 'I go to Sterne,' on a few simple physiological principles, he used to say, ‘for the feelings of hu- and blue pill - repressed inquiry in others. man nature, Fielding for its vices, John. But his success in tracing the influence son for a knowledge of the workings of of disordered digestive functions on all its powers, and Shakspeare for every- diseases, produced a cloud of works, and thing. Though a keen observer on the a host of imitators; some of whom forgot humorous side of our foibles, which, to imitate his sense, when they affected however, he set down with naught of his singularities ; while others thought malice, he possessed, like most men of a they were adding to the value and numsimilar cast of mind, much of the pathos, ber of his principles, by reducing them to as well as the irritable humour of that vulgar fractions. It is not very long since species of muser, of which Jaques is the the minutest trifles were gravely expectideal.*

ed to be written down for the guidance This rare union of qualities gave of those who seemed to have lost, with weight to opinions, which it would ap- facility of digestion, every faculty of mind. pear Abernethy had formed very early in The result was, that it afforded a fine field his professional life, and which he re- for all who knew and could take advantained without much addition or diminu- tage of that feverish state of alarm intion to its end. These were one-sided duced by undue attention to trivial corand exclusive in this respect, that he did poreal sensations. To those who would not himself follow up the improvements trace the effect of mental attention on of his age-while his dicta, in as far as the bodily organs, we recommend the

5th chapter of Dr. Holland, where they Lawrence's portrait gives one phasis of Aber. will not only find the rationale, but the nethy’s aspect very happily ; but who can paint example of this pernicious habit, as afanything of the manner which set off such a seem: fecting most of the vital organs of our these words ?— Local injury or irritation frequent- frame, one and all of which will soon ly produces a state of delirium, in which a man is transmit diseased sensations to that brain, utterly unconscious of his situation; he goes on which is predetermined to harp on them. imagining things, as in a dream, and acting in con. sequence of such imaginations. Delirium often takes place in consequence of an accident of no

• A direction of consciousness to the region of very momentous kind; it may occur without fever, the stomach creates in this part a sense of weight, or it may be accompanied with that irritative sym- oppression, or other less definite uneasiness; and, pathetic which I described to you in the last lecture, when the stomach is full, appears greatly to disturb and which is often the “ last stage of all, that closes the due digestion of the food. It is remarkable the sad eventful history” of a compound fracture. how instantly, under such eircumstances, the effect Delirium seems to be a very curious affection; in comes on; a fact readily attested by experiment, this state a man is quite unconscious of his disease ; which every one may make for himself

. The symp. he will give rational answers to any questions you toms of the dyspeptic patient are doubtless much put to him, when you rouse him; but, as I said aggravated by the constant and earnest direction of beforc, he relapses into a state of wandering, and the mind to the digestive organs, and the functions his actions correspond with his dreaming. People going on in them. Feelings of nausea inay be prowho are delirious and suffer pain have generally duced, or greatly increased, in this way ; and are uneasy dreams; but delirious patients seem often often suddenly relieved by the attention being dito have undisturbed and even pleasant dreams. I verted to other objects.'—p. 66. remember a man with compound fracture in this hospital, whose leg was in a horrible state of slough. It is to avoid the injurious effects of ing, and who had delirium in this state. I have incessant watching over such symptoms, roused him, and said, “ Thomas, what is the matter that Dr. Holland advises the dyspeptic to with you ? how do you do ?" He would reply, "Pretty hearty, thank ye, nothing is the matter dine from a simple and discreet table at with mc; how do you do ?” He would then go regular hours; but he well adds, that if on dreaming of one thing or another. I have this rule should bring him to a solitary listened at his bedside, and I am sure his dreams meal set apart for himself

, more of ill than were often of a pleasant kind. He met old ac. quaintances in his dreams; people whom he re.

of good results. When the stomach is membered “lang syne ;" his former companions, full, the less the mind has to do with it his kindred and relations, and he expressed his dc- the better-a lesson on which all who light at seeing them. He would exclaim every endeavour to digest at the same time now and then, “ That's a good one," heard a better joke,” and so on. It is a curious tough chops and mental food of equal recircumstance, that all consciousness of suffering is distance, in the shape of reports legal and thus

cut off, as it were, from the body; and it can. parliamentary, should ponder. There are not but be regarded as a very benevolent effect of few individuals more dyspeptic than those Nature's operations, that extremity of suffering should thus bring with it its antidote -Abernethy's who pursue day after day the above regi. Lectures, p. 20.

men, and fewer who are not surprised at

meal.

the effect of only two mutton chops and remedied this defect by a species of valve regular hours.'

formed of the inner lining of the stomach

itself, which, by jutting over the aper“For the guidance of patients themselves, those rules of course are best which are most promptly ture, closed it, by simple apposition withand safely applied; neither harassing the mind by out adhesion; so that it could be readily anxieties of choice, nor the body by encouraging pushed aside whenever Dr. Beaumont wayward fancies as to methods of prevention or wished to have ocular demonstration of cure. If, for example, I were to specify any gene the process of digestion in a living man, ral maxims as to food, preferable to others from distinctness and easy application, and serving as a

or when he chose to insert directly into foundation for lesser injunctions, they would be the the stomach any of the articles of food. following :

In 1825 experiments were commenc' First, that the stomach should never be filled ed; but as St. Martin decamped without to a sense of uneasy repletion. Secondly, that the rate of eating should always be slow enough to al- his master's leave or knowledge, we low thorough mastication, and to obviate ibat un must suppose that they were, we will not easiness which follows food hastily swallowed. say unpalatable, but not agreeable to St. Thirdly, that there should be no urgent exercise, Martin. Four years elapsed ere he was either of body or mind, immediately after a full heard of, during which period he had la

* The simplicity and familiarity of these rules boured hard for his livelihood, had marmay lessen their seeming value ; but in practice ried, and become the father of two childthey will be found to include, directly or indirectly, ren. It being by chance ascertained a great proportion othe cases and questions that he was in the service of the Hudwhich come before us. And many such questions, as, for example, those which relate to different son's Bay Company, Dr. Beaumont, qualities of food, would lose great part of their dif- with most laudable zeal, succeeded, at ficulty were these maxims successfully enforced. great expense, in having the man and his When the quantity taken dues not exceed the just family transported to him a distance of pared by mastication, and by admixture with the 2000 miles. St. Martin's health was persecretions of the glands which aid the first stage fectly good, although the aperture into of digestion; and when no extraneous interruption the stomach remained pervious. A seexists to the proper functions of the stomach in this ries of experiments were now tried on stage; the capacity of digestion is really extended as respects varieties of food, and tables of relative him, from August, 1829, to March, 1831, digestibility lose much of their value.'-p. 344. during the whole of which time he con

tinued to perform the duties of a comLatterly, a very remarkable opportuni- mon servant in Dr. Beaumont's family. ty has been afforded of verifying on the He then asked and obtained leave to go human subject much that was conjectural back to Canada, but once more returned or incomplete in the doctrines and facts in 1832, under the express stipulation of relative to digestion; and as we shall twelve months' further experimentation. have to refer more than once to the re- The details have now been published by sults, we may as well sketch the extraor- Beaumont, and commented on, among dinary story of Alexis St. Martin.

others, by Dr. Holland. Dr. Beaumont, a physician in the army On pressing back the valve over the of the United States, while serving in the orifice into the stomach, the internal surMichigan territory, was called to see a face of that organ could be seen for the robust youth of eighteen, who half an space of six inches, and the food could hour before had been desperately wound- be perceived not only at the moment of ed by the accidental discharge of a gun, its entrance, but during the whole period the contents of which entered the chest that it remained there ; so that all the and passed in an oblique direction into the mechanism of a vital action hitherto stomach, and out through the neighbour- known by indirect means alone was exing integuments. There were therefore posed to the senses. The time and cir. two perforations; an upper, from which a cumstances under which the secretion of portion of the lung, and a lower, from gastric juice took place, the motion of which a part of the stomach protruded. the stomach, the temperature necessary The cure was protracted during a year, for the digestive process, the appearance at the end of which time the orifice in the in health and in disease of the mucous chest was completely cicatrised, while membrane lining the organ, and many that in the stomach remained open to the other states and facts, were definitely extent of two and a half inches in circum- made out by the accident of which Dr. ference, permitting the food to escape Beaumont made such good use.

His exunless prevented from so doing by the periments were painless, and we add application of a pad and bandage. In with much pleasure that they appear to another year (the spring of 1824,) nature have been conducted with a discretion

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