« PreviousContinue »
Quod non imber edax, non Aquilo impotens
Annorum series, et fuga temporum.
Whatever may be the fate of my reasoning in public estimation, the facts which have resulted from it will, in permanency, class with the physical elements of nature, will endure as long as the present economy of the universe, and when the author and his commentators shall have immemorially passed away, in the mighty wreck of decomposing substances!'
Whether this sonorous climax belongs to the sublime or the bathos, let the Scribleri of the day determine: whether it is the assurance of vanity and imbecility, or the confidence of genius, we do not feel it necessary to enquire.
The purport of the author's dissertation is to establish the following positions: a brief analysis of his reasoning will evince how far he has succeeded in his design. He maintains
that gout differs in no essential circumstance from common inflammation; that it is not a constitutional but merely a local affection; that its genuine seat is exclusively in the ligamentous and tendinous structure; that its attack is never salutary; that it should neither be encouraged nor protracted; and that, if scasonably and appropriately treated, it is as easily remediable as inflammatory excitement on the muscular, cuticular, or any other description of organic texture.' P. 7.
The first chapter, which professes to treat of the origin of gout,' contains not one word upon the subject, except a conjecture that it must have been nearly coeval with that of human existence,' because its causes must have existed in the earliest times. But had he dated its origin from the first manufacture of spirituous or fermented liquors, the view, though it would have been less new, would have been more distinct, and, we apprehend, more correct.
Gout, we are next informed, is not a constitutional, but merely a local affection; and it consists of simple inflammation, modified by the structure of the parts in which it is seated.
Idiopathic, or true gout, or rather that inflammatory affection of the joints, which popular consent has denoted by that name, has its station exclusively in the ligamentous and tendinous structure. The dense compactness of this fabric gives to its nervous, vascular, and cellular substances, sentient, irritative, and resisting powers, peculiarly adapted to induce the painful confi ct sustained, when, from any cause, these parts are subjected to inflammatory violence. Strong derivant excitement, impulsive afflux of fluids, and unyield ing contractility of vessels, are sufficient to furnish the most de tressful phenomena of gout.
If this disease, then, has for its seat organic texture, that im
parts to it a specific modification, it is obvious that a different arrangement of parts must be incapable of affording precisely similar effects; and that consequently where this structure does not present, whatever be the morbid excitement, the formality of gout cannot be strictly recognised.' . 9.
This affected jargon, which is more intelligible than the greater part of the author's sesquipedalian phraseology, contains the sum of the argument against the established belief that the disease is constitutional: and it is repeated again and again as an answer to every objection that suggests itself. But it is obvious that he deludes himself with words; that he founds his theory upon a mere assumption, from which he reasons in a circle; and that his concluding position is equally gratuitous with the original assumption, being in fact but a repetition of it in other terms. His argument may be stated thus:,' gout is exclusively confined to tendinous, which is local structure; ergo gout is not constitutional.' Or: 'gout is not constitutional, because it is merely local.' Excellent logician!
Perhaps this specimen is sufficient to convince the reader that Dr. Kinglake's new views regard, not the phenomena, but the terms by which they are distinguished; and the mode in which he explains away those facts, which are within the experience of every practitioner, will be easily anticipated. Proceeding in this verbal illusion, he gives them another name, and believes that they do not exist. It is true indeed, he acknowledges, that there are disorders of the viscera, as well as of the constitution at large, which accompany the local paroxysm, or which succeed to, and alternate with it. But these are not gouty. They are only complaints, which, in such circumstances, arise from different states of sympathetic energy, and visceral susceptibility for associative or sympathetic impression.' P. 38.
'The crratic, or misplaced gout, has no admiss ble significancy in either the theory or practice of the disease. It implies visceral or systematic affection, arising from its declining or shifting station on the joints. This resolves itself wholly into the greater [more] or less transient effects of sympathetic irritation.
If, in these circumstances, either the brain or any other vital organ be affected to the extent of inflammatory excitement, the effect will not differ from that of common inflammation. It cannot be what is termed gout, as the brain, as well as every other vital organ is destitute of the ligamentous and tendinous structure, necessary to that sort of inflammatory affection.
Misplaced gout then is a misnomer; when it holds not its natural situation, when it occupies not its indispensible structure, its existence is no where but in branular fiction. P. 42.
The fiction, we believe, is of Dr. Kinglake's creation, and
he is its principal dupe. It is difficult indeed to conceive, that, admitting in these explicit terms the occurrence of those phenomena, which are connected with inflammatory or local gout, he could suppose that the invention of a different name constituted the discovery of a difference in their nature; or that he could thus deduce any inference as to a difference of practice. Had he shewn us, that those affections of the system or of particular viscera seldom or never supervene to the suppression of the local disease; or that the general apprehension of practitioners is carried to an extent, which more accurate observations do not justify:, or had he ascertained, and pointed out to us, any circumstances which might guide our prognosis with greater certainty, as to the probable occurrence of those affections: or lastly had he taught us how the danger of their occur rence, where it existed, might be obviated or diminished; he then might have drawn, with justice, the conclusions which he now assumes, and recommended with safety the practice which he founds upon that assumption. We opened his volume with the hopes that all this had been done; and we still think that nothing less than this can justify a practical innovation, which, in the general opinion, supported by the authority of Sydenham and of Cullen, is replete with danger. The connection of a visceral or constitutional disease with the sup pression of the external inflammation, is the point in question. if a dangerous or fatal disease in the stomach frequently ensues on the sudden removal of the inflammation of the foot, it is of no importance in the theory or practice of the latter, whether there be ligament and tendon in both parts, or whether the diseased actions be in both cases similar. This truth appears to us too obvions to be dwelt upon. But it may be remarked, that Dr. Kinglake has fallen into an error, in supposing that repelled gout, as it is called, consists of inflammation in all instances. In the stomach it is more commonly a spasmodic affection or a state of atony, and syncope occasionally accompa
Dr. Kinglake's next position is, that gout is essentially the same with all other forms of inflammation, which are distinguished only by the structure of the parts inflamed.
Different degrees of inflammatory affections of the ligaments and tendons have been erroneously supposed to be essentially distinct diseases, and have accordingly received such respective denominations, as have been held to be appropriate: thus an inflammation on those parts, arising from general causes, is at one time distin, guished by the term rheumatism; at another, when the inflammatory irritation has resulted from external violence, particularly that of extension, it is named sprain. It will require no extraordinary skill in independent thinking, to perceive the perfect identity of
these several nominal states of inflammation, and to refuse assent to the prevailing prejudice, that they are essentially different.' P. 10.
With the same skill in thinking', he remarks, P. 16, that lumbago, sciatica, and white swelling of the joints, are various examples of inflammatory excitement, of the same structure as that which is the seat of gouty irritation; and these acknowledge no other difference than what consists in degree and situation.' And in support of these observations he frames a law of nature: It is a law in the organic movements of the animal economy, not only that similar structure necessarily evolves similar action, but that the healthy, as well as distempered conditions of that action, are also associatively bound in indissoluble participation.' This sweeping generalization is, in our opinion, equally inconsistent with that accuracy of research, which can alone contribute to accurate arrangement, or a good theory of diseases, and with an appropriate application of remedies. We know nothing of morbid action, but from its appearances, relative connections, and consequences; and these should be all carefully marked, and all comprehended in our view of any particular disease. If we limit our enquiries to the one or the other, our knowledge will be necessarily incomplete. Thus, admitting for a moment that in those two degrees of ligamentous inflammation, which are commonly called white swelling and gout, the appearances or local symptoms should be undistinguishable, it would be careless and unphilosophical in the extreme to class them together at once, without regarding the collateral circumstances;-the very obvious difference in the state of the constitution at large;-the different states of the viscera in particular, and their sympathies with the local disease; the hectic, and the slow imperfect suppuration, which uniformly terminates the one case, and the very peculiar deposition which is consequent to the other. These different changes in the fluids secreted, these distinct products, which result from the morbid actions of parts possessing the same structure, seem to us to imply a difference in the nature of those actions, and therefore to justify a difference of treatment. They are extremely adverse, in our opinion, to Dr. Kinglake's law just quoted. We shall therefore conclude this topic,-after expressing some doubts, whether inflammations of the most specific nature, with respect to cause, such as variolous, vaccine, venereal, scrofulous, cancerous, &c. are perfectly similar in the effect of excessive excitement, and are curable in the same way,' (P.37)--with recommending to Dr. Kinglake a serious perusal of the observation of Lord Bacon, which he has very appropriately prefixed to his treatise:- Medicina, in philoso phia non fundata, res infirma est.'
The author's observation (P. 34) would appear à priori to be extremely just; to wit, that an early removal of the gouty paroxysm would contribute to prevent that lameness and distortion of the parts, which frequent and protracted fits produce, and that with the avoidance of those local injuries will be connected a constitutional escape from the morbid sympathies, and the visceral affections, which lingering and aggravated inflammation is apt to induce.' We heartily wish that experience may support this conjecture, as well as the safety of an early suppression of the local disease. But, after all, the preservation of the constitution must probably depend on the preventive means, which are mentioned in a subsequent chapter.
The causes of gout are the subject of discussion in Chap III. As Dr. Kinglake considers the disease as simple inflammation, all the ordinary causes of inflammation are enumerated in his list of remote causes of gout. We would willingly quote the doctor's words, in order to afford our readers a specimen of his skill in thinking,' of the perspicuity of his conceptions, and of the simple and intelligible style in which he delivers them, but must content ourselves with transcribing his account of the proximate cause.
The proximate cause of gout results from the aggregate effici ency of the remote causes, and is truly the disease itself. This efficiency or proximate cause, by which the disease is constituted, consists in an agitated and an increased degree of vital or repulsive motion in the affected parts.
By vital motion is meant a repellency, subsisting between the constituent particles of all matter. This innate power or property is, by a law of nature, spontaneously evolved froin atomical surfaces, and assumes character and determinal force, when issuing from the congeries, or combination of material substances, which forms specific or particular structure.
The exertion of this universally repellent power, in the organic fabric of the animal economy, is life, or vital motion. The action of this power deuotes itself in animal feeling as heat; an undistin guishable identity, therefore, with respect to the object, subsists Between what has been variously denominated repulsive motion, vital action, and heat. These several modes of the same thing arise from the different circumstances in which it is operative. Repulsive motion is the natural efficiency of matter, and universally pervades every conceivable atom; vital motion is the organic efficiency of matter, and heat is the impression only, which that power makes on animal sensation.
• In this view of the nature of vital power, it will be easy to perceive the ground of its morbid excitement in gouty inflammation, as well as in every other variety of disease; it also instructively developes and explains the real cause of all the distressing torture occurring in inflammatory gout, to consist in almost a combustive degre of redundant beat, or repulsive motion.' `P. 76.