ART. XIV.

Practical Observations and Suggestions in Medicine. By MARSHALL HALL, M.D., F.R.S., L. & E., &c. &c.--London, 1845-6. First series, 8vo, pp. 360; Second series, 8vo, pp. 360.

In our Number for April, 1845, we noticed a volume of Observations in Medicine,' by Dr. Hall. We noticed it merely, and out of kindness to the author, because we felt convinced that an impartial analytical and critical review of the volume, must necessarily detract from the reputation already acquired by Dr. Hall. The appearance of another and a similar volume recalls us to a juster sense of our duty,-reminding us that there is something due to the character of British medical literature and science, and that a tenderness for the faults of an able man ought not to render us disloyal to truth. We therefore now propose to review these 'Observations' more in detail.

In our previous notice, we said that a man with the reputation of Dr. Hall could not afford to bring out an inferior book, for his own sake: we now say that, for the sake of others, he must not be allowed to bring out one inferior book after another, unless a just estimate of them is laid before the profession at the same time. Example in high places is as potent for ill as for good; and the name of Dr. Hall may make that pass current which would be at once rejected under a lesser warranty. In criticising the volumes before us, we shall distinctly state the grounds of any opinion we may express regarding the author's merits; and, doing this, our readers will themselves be able to criticise the critic.

The author's objects in publishing these volumes would seem to be various; they have all, however, a reference either to the student or the practitioner. In the first place, Dr. Hall evidently desires to set himself up to both as an example and a teacher. This purpose discloses itself in the very beginning of the book. Among the "introductory remarks" of the first volume, in the section on fertility in remedial resources," as a requisite in an able physician, we have the following:

"If the following Observations and Suggestions' prove that I have not cultivated this subject entirely in vain, and lead other physicians into the same useful train of mental culture, I shall be amply rewarded for the pains which I have taken in embodying them in language and laying them before the profession.

"I have published these 'Practical Observations and Suggestions' in an unpretending form: first, that they may appear in the modest manner becoming such a trifle; and, secondly, that they may be readily portable; for my ambition is, that they may become the companion of the student, and of the country practitioner, in some of his lonely drives, especially of those whose time is too much taken up by practice to admit of their reading larger and denser volumes.

"I have also wished not to deter, by the form of this work, the general reader, who may be interested in medical matters generally, or in some particular medical subject." (Vol. i, p. 3.)

Another object appears to be, the promulgation of the author's therapeutical experience, or the communication of methods of treatment already found useful by him-such as the daily scarification of the gums in infancy, the alcoholic lotion in phthisis, &c.; or of hints or suggestions of

treatment derived from analogies, or from physiological ratiocination, as the cold douche to the loins in sterility, the cure of vascular nævus by puncture, &c.

A third object of the author is the republication of essays formerly written on various subjects. Of this kind are the chapters on "intestinal irritation,' "exhaustion from loss of blood," "the sinking state from various causes, ," "on hybernation," &c.

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A fourth object is to make the work a sort of receptacle for the lucubrations of friends, and for their hints, observations, and suggestions. When we consider how freely open the numerous weekly and monthly journals are to the reception of communications of this kind, we think this altogether unnecessary, and at variance with the other objects of publication. The observations we allude to are certainly not "Observations by Dr. Marshall Hall."

Dr. Hall's volumes are also "intended to be suggestive of new observations, as well as the record of some observations of his own;" and, in giving these suggestions for new observations, the author indicates special objects of inquiry, propounds the principles of observation that should be adopted, and lays down the plan that should be followed. The subjects indicated for observation are detailed in vol. ii, p. vii.

The following extract exhibits the principles propounded by Dr. Hall as the guide to students and practitioners in conducting the suggested

observations:

"I am persuaded that physiology, or a knowledge of the healthy actions, is the only foundation for practical medicine, and the only remedy against the hydra, quackery, now so prevalent, both in and out of the profession. This physiology should be at once experimental and clinical. The biblio-physiology of the day can issue in no good whatever. The medical mind wants discipline; we should study the works of Harvey and of M. Louis; experiment, and observation, and philosophy should go hand in hand....... When every member of our profession has a sound knowledge of physiology, derived from his own cautious observation, and not, at second and third hand, from books, medicine will take its just position, and quackery its departure. But whilst a medical person can be found to boast that he, forsooth, is a mere practical man,' quackery will continue. One kind of mere empiricism is as good as another." (Vol.ˇii, pp. v, vi.)

These principles of clinical observation we cannot object to, as they are almost the same as some which were advocated in the correspondence elicited by an article published in this Journal last January, and particularly in one of the letters addressed to the editor in the Twenty-first Volume. We are happy to find that these views, although omitted in the first volume, find so prominent a place in the second; and we are the more gratified, because we can bring Dr. Hall's "purely useful and practical" observations to the test of his own avowed principles without any demur on his part. It is rather pleasing, too, to find our author laying down a "plan of observation of diseases of the nervous system," prefaced by this declaration: "If we wish to pursue the subject of clinical observation in general, we have fortunately a perfect model and example in the writings of M. Louis."

The value of the new therapeutical experience recorded by Dr. Hall varies extremely. As an example, we will take the first practical point in the first volume, and we think it will not be difficult to show, that the

observations recorded in that chapter have not been made under the guidance of physiology, but that they are in absolute contrast to the "perfect model and example of M. Louis," whilst the whole chapter displays, as we shall subsequently point out, a spirit and aim very remotely related indeed to the lofty aspirations of the author. The chapter is headed, “On the use of the alcoholic lotion in phthisis pulmonalis."

"So many persons affected by incipient phthisis, marked by dulness of sound on percussion, and no doubtful pectoriloquy under the clavicle, hæmoptysis, and disposition to chills, heats, and early morning perspirations, &c. have been benefited and restored to apparent health by the remedy, or remedies, which I am about to mention, that I cannot but think they possess great efficacy. The first and the principal of these remedies is an alcoholic lotion constantly applied by means of six folds of linen over and across the upper lobes of the lungs. One part of pure alcohol is mixed with three parts of water. It is applied tepid at first, afterwards of the temperature of the atmosphere. It is applied, in small quantity at a time, every fire minutes, so that the application may always consist of alcohol and water." (Vol. i, p. 25.)

On the next page we find the alcoholic lotion gets all the credit; but still Dr. Hall's practice is successful.

"It is by no means my wish to laud this remedy beyond its just value; but 1 have no hesitation in asserting that it possesses a power in checking the progress of the deposition and softening of tubercle in the lungs, beyond any other which I have ever tried. And the number of patients who have recovered from incipient phthisis under its use, and who, after many years, are still living, and in apparent health, induces me to express myself in strong terms in regard to its extreme value." (Vol. i, p. 26.)

Then follows the list of cases, much in the style of those which usually are found to clench quack advertisements: for example—

"One patient, who consulted me fifteen years ago, had dulness on percussion and pectoriloquy, and every other sign of incipient phthisis. He applied, and long wore, the alcoholic lotion, called it his 'breast-plate,' and is now a professor of

College.

"A lady, about 30 years of age, became affected with haemoptysis, and displayed the physical signs and the usual symptoms of phthisis. She was enjoined the alcoholic lotion. It is fourteen years since it was first applied, and it is continued, or renewed, if ever suspended, to this day.

"I saw a young lady two years ago, one of a most consumptive family, affected with haemoptysis, and with every threatening sign and symptom of incipient phthisis. I prescribed the alcoholic lotion, and the cough and haemoptysis were removed, and every fear dispelled. It had already been proposed that this young lady should take a voyage to Madeira. She did so, continuing the lotion, and returned in apparent good health.” (Vol. i, p 27.)

Now, if these general statements mean anything, they mean that certain individuals labouring under phthisis pulmonalis were cured by the use of this alcoholic lotion. They mean this, and nothing less. But an indistinct idea seems to have passed through the author's mind, that his professional reader might bring some common sense to bear on the subject, and demur to the facts. We therefore have him stating, "I do not imagine that the alcoholic lotion does more than check the morbid processes." Nay, he goes further; he even doubts whether it even effects this:

“In what the morbid processes of the deposition and the softening of tubercle

consist, I believe we do not know; but if these processes be really checked by the application of the alcoholic lotion, we have a practical fact which must excite the deepest interest. Some degree of this influence, in incipient cases, is, I believe, exerted by this remedy." (Vol. i, p. 28.)

What, then, is the therapeutical experience in this chapter? Firstly, Dr. Hall has no hesitation in asserting, that the alcoholic lotion possesses the power of checking the progress of the deposition and softening of tubercle; nay, "a number," and "so many," have been "restored" by it from what he calls "incipient phthisis," but which we must call confirmed phthisis, seeing there was "dulness of sound and no doubtful pectoriloquy under the clavicle"-that he cannot but "express himself in strong terms in regard to its extreme value;" and then, on the next page, all this is softened down into "if these processes be really checked by the alcoholic lotion," and "some degree of this influence is, I believe, exerted," &c. I believe ! —some !-if !—are these the terms to use regarding a remedy for an incurable disorder after "I have no hesitation in asserting ?"

We have scanned this chapter carefully, hoping to discover the slightest hint of the numerical method, or the smallest modicum of physiological science. We trusted that there might be at least one line which would indicate, however so obscurely, the physiological principles which had led Dr. Hall to the use of the remedy, and which would elucidate its modus operandi. But the result of our most careful analysis is, in the language of the chemist, not a trace. As for the "perfect model and example of Louis," we need only observe, that they are just as utterly wanting as the principles of physiology. Even the language is singularly loose and indefinite. For example, the folds of linen are ordered to be applied "over and across the upper lobes of the lungs a mode of wording, moreover, as if it were meant to indicate the rationale of the practice. To say nothing of the next-to-impossible feat of applying the remedy every five minutes,"-yet one lady seems to have done this for fourteen years!— not a hint is given as to how the influence of the alcohol reaches the morbid tissues, and when there, how it effects the beneficial change. There is not, we repeat, the slightest attempt at a physiological or numerical consideration of the nature of tubercle, or of the means by which the deposit may be prevented or removed. Yet, surely, if the "perfect model" and example afforded by Louis be ever worthy imitation, it is in investigating the nature and cure of phthisis pulmonalis.

There is a chapter "on the treatment of lateral curvature of the spine," and here we made sure of physiological observation. The pathology of spinal muscular action is so manifestly an important branch of the "true spinal" doctrines, that we were warranted in fully expecting from Dr. Hall an application of those doctrines to the pathology and therapeutics of lateral curvature. What Dr. Hall has really done shall be here stated:

"The plans for the treatment of curvature of the spine which I propose, have three objects in view :-The first is the restoration of the natural form. The second, the renutrition of the weak and emaciated muscles. The third, the restoration of the health and vigour of the general system. I propose to accom. plish my first object by stays applied to the curvatured form, so constructed as to

give the most perfect support without inducing the least injurious pressure, either on parts too protuberant, or on others, as the axilla or the ilium, taken as points of support.

"Let the patient be artificially made to assume the straight or perfect form by means of posture, stretching, and pressure; under these circumstances, carefully preserved, let a cast of the bust be taken in plaster of Paris; from this cast let a mould in wax be taken; lastly, on this mould let stays of steel be accurately fitted (or let copper be deposited by means of the electrotype and sawn in two vertically). This is to be covered and lined with soft leather and slight wadding, and fixed and worn in the ordinary manner, drawn to the proper degree of tightness.

"It is obvious that, these stays being put on and fastened in the recumbent posture, the bust must retain the perfect form, although the patient may now resume the erect position; that no partial or injurious pressure will be made on any part; and that there is neither any constrained position, nor any obstacle to the due use of the muscles." (Vol. i, pp. 55-6.)

All this is apparently theoretical: if Dr. Hall can produce the cases in which he has so applied the stays, and successfully, we trust that he will do so. A reference to the general practitioners in attendance-whom he is always so careful to name-will suffice. The next step in the treatment is thus described:

"In order to accomplish the restoration of nutrition in these atrophied muscles, something more must be done; and this remark leads me to a second proposition for the treatment of these distressing cases. It is that of inducing, by means of rubbing, what I will designate counter-muscular effort.

"If, whilst the patient is sitting perfectly erect and unsupported, we press on any given point along the spine with the finger, every [?] muscle situated below the point of pressure is necessarily [?] called into a state of action, which (action and reaction being equal, but in contrary directions) is, in degree, commensurate with that of the pressure, unless, indeed, the patient yields to the pressure. In this manner, any one of the numerous muscles situated on either side of the spinal column may be called into action at will, [?] and this by means of the very friction which was formerly used in a form that may be termed inert, and in a degree proportionate to the pressure with which it is applied.

"The patient being placed unsupported in the erect position, the hand or hands are to be passed along the muscles of the spine, pressing, at first very moderately, then more and more firmly, whilst they are carried upwards and downwards alternately, in the ordinary manner of rubbers. At every successive instant a fresh set of muscles is called into action more particularly, whilst the whole system of the spinal muscles is made to contract together, or in their turn." (Vol. i, pp. 58-9.)

Dr. Hall would have his readers infer a therapeutical novelty here; it is, however, nothing more than the old method of shampooing, kneading, &c. combined with gentle friction : friction alone is rarely, if ever, recommended by professional men. The physiological novelty is in the explanation of the modus operandi, which is, in truth, a most improbable hypothesis, namely, that on pressure being made on any given point along the spine, action takes place in every muscle situate below the point of pressure in a degree proportionate to the amount of pressure. In the treatment of curvature of the spine it is necessary to anything like success, to ascertain the exact muscles implicated in the distortion; then the nature of the morbid muscular action; and then the causes. Distortions of the bones, joints, or muscles usually, if not always, take place from unequal muscular action, consequent upon either disease of