We have no wish, however, to leave an unfavourable impression of M. Ferrand’s very able pamphlet on our readers’ minds. On the contrary, we refer them with confidence to the work as a repository of a large amount of accurate and careful thought and observation on the nature and the remedies of the pyrexial state.
A Practical Treatise on Perimetritis and Parametritis. By J. Matthews Duncan. Edinburgh: Adam and Charles Black. 1869.
Though we have nothing to do with the pathology of this work, it may be as well to explain the meaning of the terms employed in the title, so that the value of the author’s therapeutics may be the better understood. Objecting to such expressions as pelvic cellulitis and inflammation of the uterine appendages, Dr. Duncan adopts in part the phraseology of Virchow, and employs the words perimetritis and parametritis, the former to signify inflammation of the uterine peritoneum, and the latter to imply inflammation of the cellular tissue in connexion with the uterus. With the justification of such a terminology we need not concern ourselves, but we may express a regret that so much of the author’s observations are confined to the natural history of these affections, and so little to the all-important problem of treatment. In a work extending over nearly 250 pages, one expects to find therapeutics represented by a greater space than that included in about a sheet of printed matter. Our disappointment, too, is enhanced when we find the author, in many instances, limiting himself to the vaguest of generalities, and, while sceptical as to opinions which do not coincide with his own ideas, credulous to a high degree on some points of traditional medicine. The only methods of treatment on which Dr. Duncan at all dwells are those of leeching and poulticing—save that, in a few words on internal remedies, he urges the use of mercury to produce slight salivation, and rejects, what many think so valuable, the employment of opium. He is strong on the subject of poulticing, and his statements are in accordance both with practical experience and à priori reasoning. He impresses seriously on his readers the importance, during the acute stage, of keeping up the poultices constantly night and day. As to blood-letting, his practice is definite, though his arguments from physiology in support of it are, we must confess, insufficient for us. Local leeching is, in his opinion, vastly superior in its effects to more distant venesection; and doubtless there is much good in the practice of applying a few leeches over the groin or to the perineum. But the following argument in favour of the former plan of distant blood-letting strikes us as being of that painfully unprecise character which unhappily is so much associated with medical research:—
“The profession in this country at least has lost all faith in this treatment, as well as in the corresponding doctrine regarding venesection of special veins of the upper extremity in disorders of the head. But enough remains in the well-known and, it appears to me, well-founded belief in the value and efficacy of the pediluvium in menstrual affections to prevent us from regarding these therapeutics as absurd; and, although not dreamt of in our modern and too self-sufficient medical philosophy, yet laws of sympathy between distant parts may be discovered which will explain and inculcate some such remedial measure, which now appears to be unreasonable.”
How, in the name of all that is “positive” in medical science, is therapeutics to advance an inch while philosophers reason to truth in this fashion? It would not be more absurd for a chemist to support a gratuitous speculation on the faith of a future recognition of phlogiston, than for an intelligent practitioner to establish a therapeutical fact by argument such as that which Dr. Duncan employs. When the author confines himself to telling us under what circumstances blood-letting should be adopted, he gives us the result of a valuable and wide clinical experience; but his hypotheses are, we confess, too much for us. We cannot understand why Dr. Duncan completely overlooks the subject of restoratives and tonics in perimetritis and parametritis; and we should be glad to hear his reason for ignoring such very important agents in the treatment of these affections.
The Atlas of Venereal Diseases. By M. A. Cullerier. Translated from the French, by F. J. Bumstead, M.D. Philadelphia: Henry C. Lea, 1868.
We wish for once that our province was not restricted to methods of treatment, in order that we might say something of the exquisite coloured plates in this fine volume; for the work is essentially one to aid in diagnosis rather than to detail means of cure. The Atlas, which Dr. Bumstead has not only translated, but very materially added to from his own stores of knowledge, is in every respect a most useful work for the practitioner, who is often called on to diagnose an affection which in the absence of a truthful history may appear either syphilitic or not in nature. With the aid of these handsome plates, there need be little difficulty in the identification of a syphilide. It must not be supposed, however, that therapeutics are neglected, or sacrificed to etiology. Both author and editor give us a very full account of the remedies now in vogue, and of their own clinical observations. We have not seen anything on the subject of the hypodermic employment of mercury, but the internal administration of the salts of mercury and iodide of potassium is of course enjoined. Indeed, the chapters on the treatment of syphilis are not the best. The section devoted to the remedial measures to be attempted in gonorrhœa strikes us as being copious and well arranged, and contains some sound, practical commentaries by the editor, who disapproves of the porte-caustique and other heroic modes, and recommends the use of an extremely weak injection of nitrate of silver (gr. ⅙ to the ℥j.) every three or four hours. His suggestions as to general treatment are equally judicious. In every respect this Atlas will be found most useful for reference by the busy practitioner.
The Medical Formulary, &c. By B. Ellis. Twelfth Edition, revised by Albert H. Smith, M.D. Philadelphia: Lea, 1868.
The aim of this work is to supply the young physician with the means of writing “elegant and judicious” prescriptions; and if we may judge by its success, the book must be one which meets a want. But we cannot help saying that the habit of writing “elegant and judicious” prescriptions is one of the barbarisms of the practice of ancient times which we should gladly see consigned to oblivion. It fosters charlatanism, and utterly retards all efforts to found a rational system of therapeutics. How can any logical induction, or any generalization of the slightest value be drawn as to the remedial effect of drugs administered after the mode laid down in such books as the “Formulary?” Without pausing to consider a recipe for pills which are “elegantly” and alliteratively styled “Chapman’s peristaltic persuader,” let us ask what can be the judiciousness of the following marvellous concoction of substances?—
Elixir of Cinchona.