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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 efficiency 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 from 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 denotes itself in animal feeling as heat; an undistin guishable identity, therefore, with respect to the object, subsists Letween 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 deve lopes and explains the real cause of all the distressing torture occur ring in inflammatory gout, to consist in almost a combustive degre of redundant heat, or repulsive motion.'`P. 76.
These observations fully justify the author's claims to novelty. We know not, indeed, whether his theory, his philosophy, or his taste, is the most truly original. And as to the air of obscurity, which hangs over the above hypothesis, and which may be said to render it almost incomprehensible, it was no doubt a part of the author's design; since obscurity, according to Burke, is a characteristic of the sublime, and Tacitus considers it as a source of general admiration. The practical conclusion, however, is sufficiently obvious. Gout is a sort of combustion;-cold water is the natural antagonist 10 fire;therefore cold water must be the proper extinguisher of gout. Q. E. D.
It would be difficult to offer a serious comment upon this luminous theory. In a subsequent paragraph it becomes still more mystical; for the doctor discovers a super-abundance of heat, where it is neither to be detected by the sensations, nor by the thermometer! either a painful or heated sensation serves to mark morbid deviation from the standard temperature; and though excessive heat should not be thermometrically discoverable at the surface, it actually prevails, as the necessary effect of commotion; and its dissipation, or transference, by cooling means, will most effectually restore the motive power to the duly repulsive or healthy harmony. P. 80.
In the next section we are directed in all instances to apply cold water to gouty inflammation, regulating the degree of the application by the degree of the local inflammation and pain. We are informed of no other limitation nor direction. It should not be forgotten,' we are told in one paragraph, that the object to be effected is literally the extinction of fire: and in the next it is said, that, as gouty excitement is kindled only by excessive heat, it is solely this exuberance that is the object of reduction.' P. 84. In addition to this, the internal use of cold water, and the careful avoidance of all stimulating food, and fermenting liquors, are prescribed. Both the local and general mode of reducing morbid heat, here recommended', must be understood to be as strictly applicable to every shifting or sympathetic attack on a fresh joint, as to the original seizure.' P. 87. Yet with a gross inconsistency, we apprehend Dr. Kinglake occasionally combines with these refrigerant operations, stimulants no less powerful than opium, camphorated tincture of opium, and ammoniated tincture of guaiacum. He employs these medicines, very judiciously, in those instances of old and protracted gout, where there is considerable debility and irritability of the system; and it is probable that their stimulant effects may have counteracted the deleterious operation of his antiphlogistic plans in such constitutions. He con
cludes this long chapter with an ample store of declamation against the folly, stupidity, and irrationality of medical practitioners in persisting in their routine of stimulation, and shutting their eyes against the light of nature and of his theory.
Section 5th, though it contains no new views, comprehends a full and judicious statement of the means of prevention in the intervals of gout, such as have been recommended by the best practitioners, from Sydenham downwards.
The appendix, which occupies more than half the volume, contains a considerable number of cases, related by the author, and by other practitioners, in which the free application of cold water was attended with invariable success: no instance at least is mentioned, in which any untoward symptom occurred; and in two or three there had been repeated attacks, and the constitution was debilitated. Several cases of acute rheumatism are also related, in which the external use of cold water was equally beneficial. The number of these cases, we must do Dr. Kinglake the justice to add, is such as to lead us to doubt, whether the common fears of repulsion, &c. are not carried to too great an extent. We therefore the more ardently wish, that Dr. Kinglake and his correspondents had been more particular in their detail of symptoms, and of the circumstances of the patient's constitution in each case. The histories are sufficiently_numerous to excite some scepticism as to the foundation of the current opinion, and some degree of confidence in the remedy proposed; but they are far too vague and inaccurate to lead to any just conclusion, or to afford even the groundwork of a satisfactory induction. The experiments must be repeated by more acute and philosophical enquirers than Dr. Kinglake and his correspondents, before the idea of danger can be justly confuted. We have only to add, that the declamation, sarcasm, and abuse which the author pours forth most abundantly in his notes to the appendix, serve but to weaken his credit, and to degrade both himself and his cause. But Tempus omnia revelat,' as he very classically observes; and we cordially hope that future investigation will confirm the safety and utility of his practice.
ART. XI.-An Account of Two Cases of Gout, which terminated in Death, in Consequence of the external Use of Ice and Celd Water. By A. Ellin. 12mo. 15. 1805.
ART. XII.-A Reply to Mr. Edlin's Two Cases of Gout, &c. S. By Robert Kinglake, M. D. 8vo. 2s. 6d. Murray.
ONLY one of the cases in question occurred under Mr. Idlin's personal observation; and, like those in Dr. Kinglake's
appendix, it is related in too general terms. A medical prac titioner was attacked with an inflammation in his foot, which he believed to be gout. He applied cold water to the part freely, and was speedily relieve!; but a sense of coldness at the stomach, faintness, fluttering puise, and coldness of the extre mities supervened, which were twice removed by strong stimulants, but on the third attack, proved fatal.
Dr. Kinglake replies to every paragraph contained in this pamphlet, in a very angry strain: and it is remarkable, that the very fault which is so conspicuous in his own book, and so completely fatal to his own doctrines, is one of the first which Dr. Kinglake discovers in the narration of Mr. Edlin; viz. the omission of the particular circumstances of the patient's constitution, as well as of the specific appearances in the case. It must be admitted, with Dr. Kinglake, that this omission renders any conclusion nearly nugatory; but it tends, in a vague way, to counteract the vague evidence, which he had brought forward on the opposite side of the question. Dr. Kinglake presumes to censure in strong terms the stimulant practice, which was employed on the accession of the retrocedent paroxysm; but had he been acquainted with the nature of those diseases of the stomach and system at large, which succeed to the repulsion of gout, and which he very erroneously supposes to be always inflammatory, he would have withheld that censure, which appears to be altogether unmerited.
On the whole, we can neither coincide with Mr. Edlin, in invariably proscribing any particular treatment, in forms of disease nominally the same; nor with doctor Kinglake in his invariable use of any one remedy under these circumstances. We have no doubt, that there are cases of gout, in which the refrigerant practice may be eminently useful, and others, in which it will be extremely deleterious. It remains for future observers to point out the appearances, which may direct our steps. In he mean time the advocates of Dr. Kinglake's practice will do well to attend to the discriminative observations of Celsus, who recommended the use of cold water, with these judicious limitations; Ubi dolor vehemens urget, interest, sive tumor is sit, an tumor cum calore, an tumor jam - etiam obcaluerit.' Lib. iv. c. 24. In the first case, he advises the use of warm fomentations; in the second, that in aqua quam frigidissima articuli contineantur;' and in the last, cool applications only. In addition to this, we apprehend, they will consider the strength or debility of the constitution, the previous number of attacks, and the tendency to affections of particular viscera. To adopt any remedy in any disease without considerations of this kind, is arrant blundering empiricism. And Mr. Edlin's case, uncircumstantial as it may be,