381

THE LANCET.

London, Saturday, June 10, 1843.

INDICATIONS OF THE RISE OF RATIONAL MEDICINE.

THE complaint that hospital physiciansand surgeons furnish the fewest possiblecontributions towards the improvement ofmedical science has been frequently made inthis Journal. An instructive and originalwork, which is, reviewed at page 386, of thisweek’s LANCET, " On Spasm, Languor,Palsy," &c., by JAMES ARTHUR WILSON,M.D., physician to St. George’s Hospital,affords us the opportunity of making an ex-

ception to this grave charge of betrayingone of the highest trusts in a civilised com- munity, and we admit the exception with

alacrity ; for, while we execrate the imbeci-lity, the inertness, the waste of opportunity,and the recklessness of the interests of their

fellow-beings, which characterise so manyofficers of our public medical charities, weare ever ready to honour the individual whoavails himself of the invaluable means that

are confided to him in those establishments,to present the proceeds of his experience,-not saving them for his own gain alone,-to the less fortunate of his brethren and the

world at large, in order that they may alsoprofit_ by his reflections and labours.Dr. WILSON’S volume, although but a

Iduodecimo of two hundred pages, comprises one of the boldest attacks upon the more

prominent doctrines of the British medical

school (we are aware that there is a largeand increasing proportion of the professionwho will read " prevailing errors") whichhas yet been made. However quietly hisassault appears to be made, yet it is not on

the outposts alone, nor with a light skirmish-ing manner. The main forts of the edifice areboldly assailed. The doctrine of the supre-

macy of the nervous system in the animal

structure is forcibly attacked. It is true,that the materials of the fabrics that he

knocks to pieces are to be incorporated in anew edifice; that in his explanations of dis.ease Dr. WILSON allows that the nerve,

being an integral and necessary part ofstructure, must be duly considered in debat-

ing treatment, and that diseases of the nervous centres may occasion, and, in a certaindegree, may be measured, by functional dis-turbance in the muscular structures ; and that

the muscular function may at times be taken

as the exponent of diseases affecting the or-ganisation of the brain and spinal marrow,as illustrated in spasm, palsy, convulsions,and the like ; but this physician abjures en-tirely the necessary dependence of these phe-

nomena upon the nerves, or the assumed

nervous power, referring them to the inher-ent vitality, or " irritability," as it is called,of the fibre.

’,The nervous structures are appended,and secondary in their nature, to the self-contracting fibre." " There is no commonfunction of the nerves." The expression11 nervous system" is true only in its anato-mical sense. " No common influences aretransmitted through the nerve to generalstructure, excepting such as have been re-ceived by the central nervous structuresfrom the blood ; the nerves vary in their

functions, as in their anatomical character,with the great organised divisions of struc-ture from which they originate." P, 58.

Dr. WILSON thus repudiates the explana-tions at present admitted by physicians, ofone half of the diseases and of one half ofthe symptoms of the remaining half, consti-tuting a modification of the theory, at presentin vogue, of nearly all the maladies whichflesh inherits.

The work is the very antithesis of sys.tematic medicine, according to the presentusage and acceptation of that term; yet theempiric will find the volume worse than use-less to him, and it is to the rational practi.tioner only that we can recommend its peru-sal. One great aim of the author is to urgeupon practitioners the importance of at-

tending to muscular action,-to " the mus-" cular function in its completeness and inte-grity."

" It should be carefullv remembered thatthere may be great disturbance of the mus-cular function, for which neither the brainnor the nerves of the affected muscles are in

any way responsible."-P. 3. " Neither inhealth nor in disease is the muscle to be re-garded merely as the organ of motion, asministering only to an occasional and me-chanical function ; but collectively, - and inmass, as the most extensive of living struc-

382 INDICATIONS OF THE RISE OF RATIONAL MEDICINE.

tures, as continually employing and em-ployed upon a large proportion of the entiremass of the blood, thus elaborating the greatcommon material of the body, and preparingit for circulation elsewhere. This is trueof the muscle at all times, whether in actionor repose. It is a necessary result of the

elementary business by which the musclelives and grows-of the common healthynutrition of its own peculiar structure."

The independent power of action pos.sessed by muscular fibre, shown by thefaculty, in living structure, of reproductionfrom the same common material-the blood-is pointed to as of the highest importance inpathology. By muscular action, however,in the observation before us, is never meantless than a result of the triple agency ofnerve and fibre with blood. The muscularfibre is influenced directly by agencies, bothfrom within and from without-by a channelmuch more direct than nerve-" the con-

tinuous universal blood." This is illustratedin innumerable instances. Spasms may be-induced by substances introduced into the

blood ; paralysis, or the suspension of mus-cular action, by the absence of principles inthe blood, the effects being directly upon themuscle, not through the intervention of

nerve. If states of the blood imply states ofthe muscle, in the full development of dis-eased action, the converse of this rule is

equally true <-" Medicine and disease work, it is ever

found, on the same living material by thesame means of living action, and thus it fol-lows that sometimes by extending the sup-ply of blood to the muscle, sometimes byreducing it, by removing hurtful principlesfrom the circulation, or by restwing thosethat are inherently wholesome,wedo, in truth,best control the symptoms of muscular dis-order."

Spasm, in its worst forms, seems to haveleast to do with the nerves of the affectedmuscles, and is compatible with the soundeststate of their structure. It is from whatoffends the blood in the fibre that spasm inthe voluntary muscles is for the most partinduced. On the other hand, there is no

state of the " nervous system," in its struc-ture or function, with which spasm of thevoluntary muscles, however violent, is notcompatible. Many spasmodic affections

depend upon impaired nutrition in the struc-ture of the affected muscles, and interruptionto the current of the large blood-vessels,rather than does compression of the trunk ofthe nerve account for cramp from pressure.

Some interesting and instructive remarkswill be found under the head of "Langour."This state is defined to be " a distressing" sense of inability to originate motion, dis-" tinct from actual weakness," page 141.It is well described by the author from

nature. Langour operates on the nerves,through the blood, or from the structures ofwhich they, the nerves, form a part. It

should be considered with reference to thevolume and quantity of the blood, and theforces which sustain and regulate its current.In its treatment the worst means are thosein general use.

Palsy, again, for the most part dependsupon faulty relations between the blood andthe brain, the latter being rendered power.less in the muscle. " He who drinks him.&deg;‘ self to death begins by poisoning his ownblood." " Palsy of the muscle does not

always originate from central injury orcongestion of its nerve. Instances are

" not unfrequent, in these days of pauperismand starvation, of persons dropping sud-" denly by the way-side, helpless and in.

articulate, from sheer inanition of the" muscular fibre."The undoubted fact that when the blood

is most charged with narcotic principles, asin poisoning with hydrocyanic acid, the coldaffusion is one of the most powerful andadvantageous remedies, leads to the infer.ence that even that agent produces its effects _

through the blood, in mass and in current.In truth, Dr. WILSON’S invasions upon thehitherto exclusive ground of nervous patho.logy are universal. Death from an exten.sive injury of the skin does not result fromirritation of the cuticular nerves, but fromthe circulation of damaged blood throughits fibre ; and even the mind first expressesitself in the body by the muscle and throughthe blood.

Dr. WILSON avows himself, with caution,to be one of the chemical school. "By" chemistry it is now proclaimed that" we are for the future to learn the

" body through the blood," and " from the" animal chemist it is probable that our

‘&deg; greatest gains will henceforth accrue,"

Importance is attached to the chemical cor-respondence between muscular fibre and thecoagulating principle of the blood. Spasm,it is suggested, by delaying the blood’s

current, may be a means of relief. This

strong action of the muscles may be for

good, influencing directly the mechanism of

383GROWING NECESSITY FOR REFORM IN THE BRITISH MUSEUM.

the circulation, and inducing further chemi.cal changes by waste of oxygen in the

blood.It may thus be well understood that,

according to Dr. WILSON, the nerves of theanimal body have been mistaken as to theirfunctions, or the part that they play in thegreat business of life; and that the nutritionof the muscular structure is the source ofthat power, in the application of which thenerves perform a secondary part. It is a

remarkable circumstance that LIEBIG, re-garding the body from a more strictlychemical point of sight, considers the sourceof vital power to lie in the nutrition of vital

parts, and particularly in that of the muscu-lar tissue. The coincidence is the more re-

markable as we believe Dr. WILSON taughtthese doctrines twelve or fourteen years ago.The Doctor follows out the subject physio-logically and pathologically, and the Profes-sor chemically and physically. Both takingthe same point of departure, the one re-

cords the results of his own observation atthe bed-side of the patient of the symptomsof disease ; the other compares the forcewhose origin he has traced with other forces,and refers it to the doctrines of force whichare universally admitted to be eternal truths,applying the principles of natural philosophy IIto the vital force. We conceive that very little doubt can exist in the mind of the

philosophic reader, that in the progress ofscience these two paths of investigationmust approach each other, and ultimatelyconjoin, to form one broad road to the temple ’,of truth, although at present, as LIEBIG hasremarked, we may not see the connection. ,

Our object in this second notice of Dr.

WILSON’S work is to promulgate his views-not to pronounce upon them; but we areinclined to believe that Dr. WILSON will not

willingly be understood by every reader.

This, however, we may say, that those

who have studied the " Chemistry of AnimalLife" of LIEBIG will most easily comprehendthe bed-side philosophy of Dr. WILSON, andwe may considerately say that as LIEBIGhas proved himself to be in advance of theage in the chemistry and physics of the

animal body, so Dr. WILSON will be foundto have anticipated his contemporaries in

some important improvements in physiologyand pathology.

THE reform of prevalent abuses in the

BRITISH MUsEUM, a matter which we

briefly noticed last week, is probably not sodifficult and distant as changes for the betterin literary and scientific institutions were

twenty years ago. Precedents and examplesin reform are now citable in many of these

establishments; and managers, and trusteesof all kinds, both civil and political, love

precedents, though they always wait for

them instead of being early in the field to

create them. Those of the British Museum

will find some in our schools of medicine,where the lecturers and pupils, who had for-merly so few interests in common (the formercontenting themselves with the smallest pos-sible exertion in teaching, the latter neverencouraged to step beyond the least modi-cum of attainment which would " carrythem through" the Hall or the College),are now uniting their energies to raise medi-cine to at least a respectable rank among thelearned professions. Museums have been

formed at the hospitals on far more ex-

tended scales for the illustration of struc-

ture, healthy and diseased; and stimu-

lants are offered, in the shape of prizesand scholarships, to industrious students,though art judged in a very absurd and un.satisfactory manner. Even the College ofSurgeons has marched a few steps in theroad of reform. The Hunterian Museum

has been much enlarged, and illustrated bycreditable scientific catalogues, and the

library is now thrown open to the membersat large,-scarcely creditable, though, that it.was ever closed against them,-and is sup-plied with new works, British and continen-tal. (Why is it not opened to students as wellas members? The latter have the most time

for reading.) The Apothecaries’ Companyhas done something in its little way to keeplevel with the times, so far as a bad Act ofParliament was interpreted to allow the

worshipful court of assistants. In the pro-

vinces, also, quite a new face has been puton medical establishments. In short, every

where the class of jog-trots is giving way.In the British Museum, however, it is desir-

384 GROWING NECESSITY FOR REFORM IN THE BRITISH MUSEUM.

able that they should yield a little faster,and as the subject falls legitimately underour notice, we willingly render the reformersof that institution a little help to effect their

purpose.

The British Museum is a national institu.

tion, supported by the country at an annualcost ranging between 16,OOOl. and 21,OOOl.(exclusively of grants for building, &c.). The

whole community, therefore, ought to enjoythe fullest possible use of the enormousamount of property which is available withinits walls for the promotion of literature and

science,-its vast collections from the ani-

mal, vegetable, and mineral kingdoms, itssplendid library of three hundred and sixtythousand printed books, and its invaluablemanuscripts. The very fact, indeed, that thetrustees possess the important privilege (con-ferred in the time of GEORGE II.) of claim-ing a copy, gratis, of every work that is

published within the United Kingdoms,should render it essentially a national li-

brary. And, with the view of setting thissubject more fully before our readers, let usenter into some details respecting the pre-sent state and effectiveness of the BritishMuseum. ’

First, with respect to its Library andReading-room. The Parliamentary inquiriesof 1835-6, which revealed so many awkwardsecrets of the fraternity of managers in this

establishment, induced the diffident trusteesto extend the hours for reading, duringsummer, until seven in the evening, thus

allowing ten hours, daily, for study duringthat season. But why not extend the hoursfrom nine to nine all the year round, and usegaslight in the reading-room, providingthat the orders for the books that are

read by the frequenters be always executedin the daytime, an arrangement which wouldat once obviate all danger from fire, the moreespecially as the rooms are all separatelyfire-proof? Were this plan once adopted(and considering that the daily readers nowaverage two hundred and fifty, it must be

adopted, sooner or later,) the doors, noweffectually barred to large numbers of

readers, would be open to men who are en-gaged in the-learned professions,-men towhom, above all others, such a library wouldbe valuable for study and research.

’ But the catalogues require great reform.The catalogue of printed books alone (exclu-sive of those of GEORGE the Third’s library)occupies forty-eight folio volumes; andwhen the enlarged edition is completed theywill be swollen into one hundred and

twenty; and yet with all this unwieldymass the arrangement at present is merelyalphabetical, with no classification of sub.

jects. Some years ago several hundred

pounds were expended, under the directionof the Rev. H. H. HORNE, and other biblio.graphers, in preparing a classed catalogue;but after the work had proceeded some waythe scheme was abandoned, for reasons

known well enough to the trustees and offi.

cers, but little satisfactory either to the Com.mittee of Inquiry or the hosts of students inthe rooms, who now spend entire hours, nay,even days, in looking for works with whichthey may be well acquainted, though they arenot able to produce their exact titles, as givenin the catalogue. This is an old and veryserious grievance, which, now that a newalphabetical catalogue is printing, we

almost despair of seeing reformed ; but thereis another, which might easily be removedby the energies of so active a librarian as.Mr. PANIZZI, aided as he is by a, positivearmy of scribes and attendants. We alludeto the delay that takes place between thereceipt of a publication at the Museum andits appearance in the room-catalogue, seve.ral months frequently elapsing before a workthat is actually in the house, can be obtainedby the readers. A special inquiry on the

part of some more urgent applicant, it is

true, may end in the production of the bookby the collector; but few persons are for-ward enough to press their demand and afterall, the obliging conduct of an individualattendant is but an insufficient atonement

for the neglect of the librarians at large!To the same cause, namely, neglect on the

part of the upper oflicers, may be ascribedthe tardy collection of new books, the incon.veniences of which are almost daily felt bythe great body of readers, or, at any rate, byall who require to be au niveuu of the litera-ture of the day.* But, independently ofnew books, very many good old medical

!II The Museum has an unequalled collec-tion of newspapers, but, owing to some ab-surd regulations of the Stamp-office, news-papers do not make their .appearance hereuntil At least two years after publication, andsometimes longer. .

385GROWING NECESSITY FOR REFORM IN THE BRITISH MUSEUM.

works of high repute, which are in the

libraries of the College of Surgeons and theMedico-Chirurgical Society, are still libri

desiderati, as respects the great national

library of England ; and hundreds of valu-able continental works and periodicals onevery subject, but on medicine in particular,are not to be obtained in any shape at theBritish Museum. Surely it would be betterto supply these glaring deficiencies, thanlavish 2,5001. yearly on bindings bettersuited for a lady’s boudoir or the shelvesof a fashionable breakfast-room, than for thehands of hard-working students.Secondly, with respect to the collections

connected with natural science, magnificentas they are, the catalogues, throughout, areso framed as to prevent them from being ofthe smallest use either to the public at largeor to students, being too scientific for theformer and too meagre for the latter. An

attempt, indeed, has just been made by theofficers (in compliance with Resolution 12of the House of Commons’ Report) to meetthe views of the million by cutting up theshilling synopsis into minor sections; butthis is a miserable half measure that will

satisfy no party, nor can the " synopsis," evenin its present form, be termed " so completeas regards what is exhibited that there islittle necessity for visitors to ask questions."(See Sir H. ELLIS, before the House of

Commons, on National Monuments). The

only plan, indeed, is to furnish, at a cheaprate (say at sixpence), a guide so familiarthat he who runs may read, for the use ofgeneral visitors,* and to produce a separateand really scientific catalogue that wouldfurnish the student with full information onthe structure, habits, and uses of the objectspresented for his examination. To makesuch catalogues is the duty of the officersattached to the various departments; and if,through want of health, talent, or disposition,those officers now holding office shrink fromthe task, others should be appointed to it

* Since making these remarks we havefound on sale at the door of the Museum, inGreat Russell-street, a little volume entitled"THE PEOPLE’S HAND -BOOK TO THE

BRITISH MUSEUM," published by D. M.Aird, at 2, Tavistock-street, Covent-garden,at sixpence, which is calculated completelyto supply this deficiency. It has evidentlybeen written by persons who have madethemselves masters of the subjects dis-played, and known what to do’ with thematerials under review.

who will bring the work to a speedy com-pletion,-" men of eminence in literature,,. science, and art, by whom such appoint-" ments would be regarded as marks of dis." tinction." (Commons’ Resolution 5.)But the want of catalogues is not a soli-

tary deficiency. In such a museum, attentionshould be paid to the demonstrations of

comparative anatomy. A comparison of thebony structure of animals might be madegenerally interesting by a proper arrange-ment of skeletons, and it would not bedifficult to show the distinctions of animals

by teeth, feet, digestive organs, &c., towardswhich not the shadow of an attempt hasbeen made. It has been objected, that suchdistinctive demonstrations are properly con.fined to museums of medical science. Theremark is worthy only of the grandmothersof museums. The knowledge would not

only be highly interesting, but would leadto habits of classification and order,which are most important to all persons.

Moreover, a few only of the specimens oflower animals are exposed to public view,the rest being confined in drawers, and opento examination merely by those who maychance to know that they exist there, andhave interest with the officers to procure theprivilege of a private inspection. TheBotanical Museum (besides a very extensive and valuable collection, comprising theSloanian, Banksian, and other herbaria) is

wholly closed against the public ; and thearrangements of it are such that, in point offact, its doors are closed also against the greatmass of medical students, to whom a know.ledge of botany is an absolute prerequisitefor the licence to practise. If this portionof the Museum were open, like the reading-room, hundreds of students would availthemselves of its treasures ; and, under pro.per regulation, the plants, or a certain prac.tically useful portion thereof, would no morebe injured by use than are the books in thelibrary.With the coins and prints we have less

business; but amongst those objects, also, thesame exclusive system prevails. Indeed,exclusiveness is the pervading spirit of thewhole institution and its managers, from the

Archbishop of CANTERBURY (the principaltrustee) and his too faithful satellites, SirHENRY ELLIs and Mr. FORSHALL,down to thehumblest attendant in the house. Every steptowards reform has been forced from them bya species of moral torture,and it is only just

386 REVIEW OF DR. WILSON’S WORK ON

now that the public is awakening to thefact that the institution is not the property ofthe officers, but simply committed to theircare for the use of the nation at large.Indeed, till within the last half-dozen years,the great mass of the community has been perfectly childish as regards its rights in

national institutions and the duties of the

parties who fill the offices of public servantstherein; but, assuredly, the time has atlength arrived when the officers of theBritish Museum, as well as all other publicestablishments, should be made to feel thatthey are to subserve, and not impede, thenational interests.

On Spasm, Langour, Palsy, and other Dis-On Spasm, Langour, Palsy, and other Dis-orders, termed Nervous, of the MuscularSystem. By JAMES ARTHUR WILSON,M.D., Fellow of the Royal College of

Physicians, and Physician to St. George’sHospital. London, J. Parker, 1843.

12mo, pp.FONTENELLE said "that all philosophy con-sisted in possessing a great deal of curiosityand very bad eyes." There was much truth

in his observation. The demonstrative

sciences afford ample proof that the asser-tion was correct, and if we bear in mindthe various names that have been given todifferent parts of organs, in compliment tothose who had developed their structure, weshall see that it has required centuries tobecome thoroughly acquainted with thatwhich has been wide open to observationfrom the beginning of time.The structure of the eye has ever been

what it is at present. Its parts are not veryminute, nor very numerous ; yet it has re

quired the successive labours of manyanatomists to develop its organisation, withthe discoveries in which are honourablyassociated the names of Petit, Willis,Soemmering, and others. Where functionhas implied suitable organisation, the pointhas been conceded, ad interim, until bettereyes have reduced hypothesis to tangibleform and figure. And what do these moderndiscoveries prove? Not how much has beendone by patient and philosophical inquiry,but how much is still to be expected by acontinuance of those endeavours, which,trusting, like faith, in what is unseen, are

finally crowned by bringing darkness to

light.The little volume of Dr. Wilson contains

a great deal that is philosophical and muchthat is interesting; but we cannot admit of

that exclusiveness of action in the produc.tion of phenomena which the author is in-clined to attribute to the blood alone; andwhen he states that " We often hear of

spasm in structure where no muscle hasbeen demonstrated by the anatomist," wemay state that the anatomist himself has yetmuch to do; and if we allow of muscularityin some structures, on the authority of theirfunctions, we may ascribe spasm to theirexistence in others, excited, as it may be,by the influence of blood or nerve.Dr. Wilson has found, in his own ex.

perience, that those fevers which are usheredin by spasm become eruptive in their pro.gress, and instances cases of spotted epide.mic fever, varioloid fever, and chicken-pox,in corroboration of his assertion. Thismanifests, by anticipation, the strong tingeof humoral pathology with which these pagesare imbued. The author lays no claim tonovelty in the statement just quoted, as it isa well-recognised fact; for Cullen observesthat small-pox is frequently ushered in byan epileptic fit, and Dr. Gregory laid verygreat stress upon this curious circumstancein his lectures on the exanthemata.We require to be reminded of such im-

portant pathological truths ; for the rarityof the small-pox since the introduction of thevaccine has allowed, perhaps, but few per-sons to become practically acquainted withthem; and the experience of others glidesaway from our memories, unless the impressis renewed by occasional repetition.The influence of mercurial vapour in pro-

ducing convulsions and paralysis admits ofmore general observation, and is no wherebetter exemplified than in the sad conditionof the workmen who are employed, for in.

stance, in the gilding of the cupolas of

churches, of which we have seen many andlamentable instances. The gold is laid onwith mercury, and the latter volatilised byheat, and many a sturdy fellow is doomed,in the prime of life, to drag on a miserableexistence for the remainder of his days,shaking with palsy, unable to convey hishand to his mouth, after the inhalation ofthis poisonous vapour.These are some of the instances which

are adduced of spasmodic action and con.vulsion caused by the influence of ’blooddeteriorated by the diffusion of poisonsthrough its mass.

" Spasm, in all cases, excepting those ofdirect local injury, implies a further effect of.

387SPASM, LANGUOR, PALSY, &.

disorder in the system than is expressed bythe irregular contractions of the affectedmuscle." * * * * &laquo;In shaking palsyinduced by mercurial poison the spasm is ofthis pervading kind. It is but one symp-tom among many of the constitutional dis-ease, and is associated with evidence ofdisordered action in every part of thesystem."Cramp, which affords the best illustration

of spasm in the double voluntary muscles,is not considered by Dr. Wilson as ever

deserving the name of an idiopathic affec-

tion,-that is to say, occurring without con-stitutional disturbance. After stating thatspasm is not necessarily connected with dis-ease in nervous structures, nor with abscessesin the brain, tumours, or ossification of themembrane, the author assumes that " it isfrom what offends the blood in the fibre that

spasm of the voluntary muscles is for the

most part induced? There are no cramps,"he adds, " so severe as those of which

poison mixed with the blood is the directcause." This affords the author an oppor-tunity of reviving the Hunterian doctrine ofthe life of the blood, which he does in veryenergetic language -" Can we refuse the inference that always

in the muscles, when thus disturbed, thereis a prejudice of the blood by compositionor in function, and by the blood’s functionhow much is implied-how much more thanthe little we know of it by its material com-position or in its mechanical relations? Thishas not been enough considered. The bloodnot only lives, but its life predominates overthat of all else in the system. It lives in themass as in the particles, as an organ, that is,with a combined function ; as an organ,therefore, universal in the body ; for theblood in the living body is everywhere, andeverywhere at once. As the air surroundsus from without, so does the blood per-vade us, like an atmosphere, from within,receiving and transmitting influences throughits continuous mass, which are acknowledgedin all parts of the system. Most of what iseffected by the blood is thus accomplished,-not by the direct admixture of materialprinciples with its current, and the subse-quent transport of such principles to theseveral organs,-not by chemical agenciesthus conveyed,-but by action inherent inthe blood itself, rapid and universal as elec-tricity, occasionally developed by the merecontact of certain forms of matter, or byagencies that are immaterial."

Again,-" It is not so much from what isadded of material to its composition, as bywhat it receives of impulse to its action, thateffects follow from the blood to the system.Cramp is among those effects, which are

most frequent in those structures where, asin the muscle, the blood is most abundant.Self-moving, self-producing, maintaining itsown fluidity, arresting its own current byself-coagulation, the blood, in its wide rangeof capacity, is affected directly and at onceby the countless agents of vital impression.Hence, from these varying states of blood,in the flesh, proceed the various symptoms ofdisturbed action that are usually termed‘nervous,’ in the voluntary muscles."Although we assent to the principle, as a

general proposition, that the blood possessesproperties which place it in a very differentlight from fluids passing mechanicallythrough tubes, but which are endowed withno special qualities, still we are not pre-

pared to attribute so much to the blood

alone, nor to endow it with such independentproperties. We must remember that thatfluid is propelled through living organisedtubes, which retain their vitality after theblood that escapes from them loses it, andthat the blood becomes defunct as soon as itis effused,-is decomposed, is an extraneousbody, is a heap of refuse, and requires theoperation of vital scavengers to remove it.It is positively certain that noxious mattersdiffused through the blood do excite spas.modic action in muscles, and we cannot

admit the occurrence of spasm where nocontractile fibre exists. Still, we have seenmany cases of idiopathic spasm where therecan have been no question respecting the

existence of deteriorated circulating fluid.In their younger days many persons neverdance without suffering subsequently fromcramp in the calves, and still have the mis-fortune to be severely pinched in drawing offlong boots, being compelled to halt with oneleg in the boot-jack. Indeed, some indi-viduals can produce cramp, at any time, inthe great toe, by bending it down upon thesole of the foot. In all such cases we wouldascribe a due share of influence to the blood,but that only of a mechanical kind. To thenerve which throws the muscle into contrac-tion we must look for the primum mobile, andwe think that Dr. Wilson has philosophicallysuggested the cause of the pain when hesays that " it may possibly depend on thecontraction in opposite directions of unequalsegments of the affected muscle." We cer-tainly believe in the existence of idiopathiccramp where the blood is in its natural state,but consider that it is excited by a deterio-rated condition of that fluid, and that, as theauthor justly observes, "There are no cramps

388 REVIEW OF DR. WILSON’S WORK ON SPASM, &c.

so severe as those of which poison mixedwith the blood is the direct cause." No

spasms were more terrific than those thatwere witnessed in some cases of the cholera,a disease arising, as we fully believe, froma specific poison diffused through the blood,producing its malignant effects on the nervesand muscles. We once witnessed the cureof a paralysed limb by the violent universalspasms which occurred in a case of cholera.An old lady had almost lost the use of herleft arm for years, and reported that she hadInffered a slight paralytic stroke. She wasattacked with spasmodic cholera in its mostpainful form, the cramps in the arms andlegs being most severe, but she finally re.covered, and completely regained the use ofthe paralysed arm.

Muscle, nerve, and blood, form an indis-soluble trinity, and healthy action dependsupon the due proportion of labour allottedto each. It is impossible for one to be

deranged without affecting the others.Action and reaction may occur between

them, producing derangement, or, as we

have seen, restoring function. The paralyticlimb loses part of its animal beat, its

muscles become flabby, and its circulationless active, and the blood which flows

through it may feel this impress, but the

palsy may have been induced by mechanicalmeans, the removal of which is followed bya restoration to its normal -condition. Thenerve shall regain its irritability, the muscleits tone, and the blood its momentum. Inother cases the blood, poisoned by extrane.ous matter, as by strychnine, shall becomethe prime offender, and, acting upon thenerve and muscle, excite them to extraordi-nary action. Still they are but meshes ofthe same web. Tread upon a fibre andthe whole vibrates.

Dr. Wilson wishes to rescue tetanus fromthe class of the neuroses:-

" By thus considering tetanus in its wideand constant relations with the blood, wecannot fail to know it in its true character ofa great constitutional disorder. Because it

begins and ends with spasm of the voluntarymuscles, tetanus has hitherto been classedwith afiections of the ’ nervous system,’ anundue limitation of the disease, for whichthere is no sufficiant warrant by the symp-toms, or in its general pathology. Like

fever, it pervades the entire system, and isspecial in the flesh, being common in theblood. A fever in truth it is, spasmodic andremittent in its character. As a fever, it

proceeds from local injury or constitutionaldisturbance, requiring for its full develop.ment a certain period of previous incubation.* * * * In familiar phrase tetanus

may be termed the muscular ferer ofpathology."We doubt whether this will meet with

general assent as regards tetanus in its

traumatic form, which the author does notexclude in his general view of the disease.It is here that we obtain the fullest view ofthe author’s opinions. Especially in this

part of the volume is it that the challenge isgiven,-Blood versus Nerve :-

41 By no irritation, by no torture, howeveringeniously devised, of any nerve, or of anynumber of nerves, in the body, would it bepossible to establish a complete tetanus inthe muscular structure under a given periodof time, varying from forty-eight hours tothree weeks."

What all the tortures of the rack andscrew cannot accomplish under a certainnumber of hours (forty-eight being the mini.

mum), is produced in as many seconds

through the medium of the blood :--" We have seen, on the other hand, that

in a few seconds a tetanic spasm, universaland fatal. of the entire range of the voluu-tary muscles, may be induced by the iu-troduction of a few drops of poison to theblood."

This is sanctioned by all the experimentswhich we have seen where poison has beenintroduccd into the veins of animals. Still,it is upon the nerves that the poisoned bloodproduces that influence which causes crampand spasm, these also being produced, if notso readily, still more quickly than the authoradmits, by simple lesion of a nerve. Dr.

Gregory used to relate the case of a waiterwhose thumb was lacerated by a piece of anearthern dish coming out as he lifted it fromthe table; spasms, convulsions, locked-jaw,ensued, and he died on the same evening.We must not indulge longer in discussions

which seldom lead to conviction, and onlylament, with Fontenelle, that we have not

better eyes to help out our philosophy,seeing through all our magnifying glasses

but very darkly as yet. Let us observe

more closely, studying the facts which pre., sent themselves-and this volume aboundsin facts of very great interest.’ The author directs attention to renaldisease and its consequences, and affords

1 proofs of the neglect of due investigationt and want of proper discrimination in treating

389

those cases. It is very satisfactory to quote such passages as the following :-" Whoever has seen a patient comatose

from retention of urine is aware of this

dependance of the brain for the proper dis-charge of its function upon the kidney; yetfew care to understand how rapidly, entirely,and fatally, the gland may inauence thenerves in their central assemblage, which isthe brain."It is surprising that the experiments ofDarwin, when prosecuting his inquiriesunder the impression of discovering a directcommunication between the stomach and the

bladder, should not have directed the atten-tion of pathologists to this important point.The ureters of dogs were tied with ligatures;the animals soon became convulsed and died,and upon opening the head serum was foundeffused upon the brain.The volume contains many things that are

deserving of perusal and investigation ; but

we must conclude, at present, with this

important quotation, our limits not allowingus to treat upon many practical points, suchas the treatment of cholera, to which Dr.Wilson directs attention :-" My inference from these cases of sudden

death from renal disease, coincident with in-tegrity of the cerebral structures, is, that inthe treatment of epilepsy, anasarca, andhydrothorax, of apoplexy, and disorders ofthe pulse and breath, the structure andfunction of the kidneys should be taken wellinto the account. Moreover, that in all dis-sections of persons who have died suddenly,the kidney should be carefully examined;and this, whether the heart, brain, lungs,and large blood-vessels be sound or not ; fordisease of the kidney is often the cause oforganic disease in the vital structures, influ-encitig their nutrition through the commonmaterial of the blood, upon the elaborationof which the kidney is uncbasingly eni-

ployed."

SOCIETYFOR

RELIEF OF WIDOWS AND ORPHANSOF

MEDICAL MEN

IN LONDON AND ITS VICINITY.

THE annual dinner of this society tookplace last Saturday at the Freemasons’Tavern, and was attended by about seventycf the members and their friends. The Dukeof Cambridge presided, and after dinnercalled attention to the fund for the relief ofthe families of,deceased members who mighthave failed in struggling against the difficul-

ties of their profession, or been worn out illits practice, and died without realising amaintenance for their surviving relations.His Royal Highness said that he felt assuredthat such an institution was exceedinglynecessary, from the very great ditlicultieswith which medical men had to struggle, andthe casualties to which they were exposed,and he was most happy to find how muchthis society had done to relieve the claimantson its funds. He then read part of the an-nual report, from which it appeared that thesociety had relieved within the past yearthirty-one widows and twenty children withnearly fl300, in half-yearly payments, andthat &pound; 385 had been added to the capitalstock, which now amounted to nearly&pound; 41,000. His royal highness hoped that

many would prove, by their contributionsthat evening, that they felt as he himselfdid, warmly interested in the prosperity ofthe society. On his own health being pro-posed, he added that he was gratified to ex-press thus publicly his best wishes towardsthe institution, and as it had been intimatedto him that he could serve its interests bybecoming the patron he accepted that officewith great pleasure, and should at all timeswillingly promote the society’s welfare.Mr. BACOT, the acting treasurer, reported

that the investment of the capital with theCommissioners for the Reduction of the Na-tional Debt, had already produced a consi-derable increase in the half-yearly income,and that the present condition of the society -0was certainly flourishing ; but that it mustbe borne in mind that, according to calcula-tions made long ago, and verified by all sub.sequent experience, the number of claimants,although actually smaller this year than inthe last, would continue to increase for thenext twenty years. To meet this demand,therefore, and to secure stability and perma.nent efficiency, would require the most care-ful management on the part of the directors,

and, the utmost exertions of friends and sup-porters. The recent investment with thecommissioners was suggested by three mem-bers, viz., Dr. Mann Burrows, Mr. Dover,and Mr. Maclure ; of the exact order of

priority he could not, however, be sure.Sir H. HALFORD briefly responded to the

toast of the Royal College of Physicians, andprofessed his cordial attachment to the so-ciety, and called attention to the generosityof the Princess Sophia and the Duchess ofGloucester, who had each again sent tenguineas, that of the Princess Sophia beingher twentieth of the same amount.

Nlr. BACOT returned thanks for " the Col-lege of Surgeons," regretting extremely thatno member of the council was present.

Mr. DREW thanked the company for thetoast of the Society of Apothecaries," and

announced the repetition this year of theirannual donation of fifteen guineas.

Sir CHARLES M. CLARKE, for the vice-pre.