ART. IX.

Thoughts on the Nature and Treatment of several Severe Diseases of the Human Body. By E. J. SEYMOUR, M.D., F.R.S., &c. In two Volumes. Vol. I.-London, 1847. 8vo, pp. 260.

INCREDIBLE as it may appear to those who shall attempt to follow us in the same path, it is, nevertheless, true, that we have gone over the volume before us three times-have literally read it thrice from beginning to end: such are the painful but imperative duties sometimes imposed on the conscientious reviewer! We had several reasons for the performance of this feat, the glory of which, we venture to believe, will for ever remain exclusively our own. In the first place, we were desirous of knowing thoroughly the "thoughts" of a man who had been long recognised as one of the busy and fashionable physicians of London, and who, over and over again, boasts, in the volume before us, of his great opportunities and exertions past and present. "These thoughts' (he tells us) have been put on paper under unceasing professional occupation" (Preface); "after more than a quarter of a century in the daily exercise of my profession" (p. 39); "in St. George's Hospital, during eighteen years' most assiduous duty" (p. 26); "a most diligent observer of post-mortem examinations, and with great opportunities for more than a quarter of a century" (p. 66). In the second place, all the diseases treated of being of daily occurrence, and consequently of great importance, we were determined that our readers should not be deprived of any information that might be in any degree useful in practice, through any disagreeable influence created in our mind by the form and mode in which it was conveyed. In the third place, we will candidly admit that we took up Dr. Seymour's volume with a slight prepossession against the author, originating in the popular reputation attaching to his name, of his being the only practical physician in Europe, under sixty years of age, who derided auscultation and set the stethoscope at nought. Having ourselves, in common with every other physician of Dr. Seymour's standing but Dr. Seymour himself, had the unquestioned and unquestionable physical truths of auscultation established as part and parcel of our mental furniture for more than twenty years, feeling it just as easy to doubt of the existence of the organs with which the phenomena of auscultation are associated as of the existence of these phenomena, or of the positive diagnostical significance of many of them; knowing, moreover, that it is impossible to do justice to one's profession, to one's self, or to the victims of many pectoral diseases, without the knowledge of these truths, and that they were, furthermore, of easy acquisition; we found it hard to conceive how any man of sound mind, of an average standard of intellect, and with even a moderate amount of moral endowment, could think as Dr. Seymour thought, and act as Dr. Seymour acted; and, consequently, we felt some difficulty in believing that Dr. Seymour could produce a medical book of any sort worthy the notice of his brethren. But this being merely à priori reasoning which, though generally just, might be exceptionally false, we determined that any prejudice thence arising should not be permitted to warp the judgment. A fourth reason for bestowing unusual attention on Dr. Seymour's book, originated in the expectation of finding

a source of interest growing out of the very peculiarity just named as a defect. Looking to the mental qualities requisite to raise and keep a man "in that bad eminence" which Dr. Seymour had attained-an eminence which certainly entitles him to be reckoned the boldest physician of his time we thought we would be sure of meeting in his practice with boldness at least, if not originality, and might thus find metal more attractive than meets us in pages which never think of catching a grace beyond the reach of ordinary art. Lastly, we found many passages of the book so hard to understand, from the singular style in which the greater part is written, that we were compelled to go over it more than once for the mere purpose of coming at the author's meaning.

We regret to state that the result of all this extraordinary labour and attention is far from satisfactory; inasmuch as we ourselves have obtained nothing which we regard as adequate to repay us personally for our trouble, and only a scanty gleaning of very ordinary materials which we can communicate to our younger readers as worthy of their notice. Indeed, the perusal of this book has been to us, in many ways, a very painful task: among other consequences, it has given a heavy blow and great discouragement to more than one of certain cheering professional glorifications in which our contented and sanguine temper has often led us to indulge. For example-it has been a favorite theme with us, in talking over the subject of professional prospects with our younger brethren, to maintain the proposition that superior talent, and learning, and professional knowledge, ceteris paribus, are sure to lead to superior success-we mean worldly success-in practice; and vice versa; and in proof of this, we have been accustomed to point to the character and actual position of all, or almost all our physicians and surgeons most estimated and best remunerated by the public. "By their fruits (we have said) ye shall know them ;" and referring to the works that have done most honour to British medical science in our day, we have had to name as their authors the very men who stand highest in the world's esteem. might be invidious to give names in illustration; but we believe it will be found that taking the twenty or thirty physicians and surgeons who have the largest practices in London, they are really, with two or three exceptions, the very men whom Science would place where they now stand. At any rate, we should find that the most eminent of them who have given books to the world, have shown themselves in them to be well entitled to take their place in the front rank of educated and learned men. То refer to a few of the works of our senior physicians only that we have had occasion within these few years to notice in this Journal, where shall we find in our medical literature writings more correct and scholarlike than those of Holland, Watson, Latham, Clark, Ferguson, Bright, Prout, Paris, &c. &c.?

It

The volume on our table, we lament to say, is of a very different stamp. It is one which, to speak mildly, it is neither creditable to a physician to have written, nor creditable to medical literature in the nineteenth century to have given forth. It is not enough to say that the book is written in a style that is careless, slovenly, and rude, often obscure, sometimes unintelligible; a considerable portion of it seems written in utter disregard of the ordinary collocation and relation of words and phrases, and not a little of it is actually ungrammatical and un-English. It would be waste of

time to adduce instances of these defects on purpose; we doubt not most of them will be exemplified in a greater or less degree in the extracts we shall have occasion to make with other views; and we venture to say that no reader can turn over three consecutive pages of the volume without admitting that our statement is not beyond the truth. Nor are the demerits of the production confined to the style merely. A considerable portion of it is really a surprising mass of confusion and bungle, without order, arrangement, or consequence; facts and opinions, observations and conjectures, the author's and other people's notions, the past and present, the right, the wrong, truisms and transcendentalisms, being all jumbled together in most admired disorder. To analyse such a work, so as to exhibit anything like a regular epitome or even outline of its contents, will be admitted to be no easy task, and is one we should never have thought of undertaking, but from the position and standing of the author. Nor, indeed, shall we even now attempt to give a regular analysis of the book, but shall content ourselves principally with noticing, as we go over the pages, what strikes us as calculated to convey information of more or less importance to our readers, whether that information be of a positive or negative, of a commendatory or a monitory stamp.

It would, indeed, be most strange-more strange even than such a wonder as this book is-if two hundred and sixty pages could be written by "a physician and formerly a teacher," after the experience of "more than a quarter of a century," without containing something not generally known, that might be of value to the younger practitioner. But even here, we must content ourselves with very moderate doings, and must be excused for so contenting ourselves; the unlucky schoolboy who, after losing himself and frightening himself in the thicket or the quagmire, has just got into fair daylight and beaten tracks, must not be expected to have a rich stock of eggs or nuts to show when he gets home.

I. The first of the "Severe Diseases" respecting which Dr. Seymour gives us his "thoughts" in this his first volume are, DISEASES OF THE STOMACH. These he proposes to treat under the head of their more prominent symptoms, as pain, vomiting, &c.; and he gives his reasons for so doing, with his wonted lucidity and elegance, in the following sentences which constitute the opening paragraph of his book:

"At first I wished to have made a distinction between disorder and disease of the stomach; but one of these appears to me to lead, when neglected, so much into the other, that I shall speak of all under one head. There are also two modes of describing the different diseases: one is pathologically, which leads to obscurity, some pedantry, and much difficulty in the adaptation of remedies; and as my only object is practical advantage, I prefer the second, which begins with what is obvious, and proceeds with what is difficult and obscure to the observation in general. I proceed, then, to speak of by far the most obvious and distressing symptom in these troublesome disorders, though often not present in the most serious ones-viz. pain in the stomach." (pp. 1-2.)

The whole essay, which extends to seventy pages, is just such a performance as this introduction prefigures. It contains nothing that is new, and represents the old things in forms that are much less attractive and intelligible than we have been accustomed to meet with them in scores of preceding treatises on this interminable theme. Dr. Pemberton's

slim volume, published some thirty years since, will convey much more information to the junior practitioner than all Dr. Seymour's whirligig lucubrations. The commonest remedies, rhubarb, magnesia, soda, bismuth, hydrocyanic acid, &c., prescribed in the commonest combinations, yet paraded in all the display of Recipes, are the staple of this part of the book. The only thing unusual in the treatment of Cardialgia which we meet with is the large doses of opium recommended in certain cases. Dr. Seymour gives a grain three times a day, and mentions a case (p. 9) where this was continued for four weeks. No doubt this is true as regards this individual case, but we have no hesitation in saying that such medication as this will generally be found not merely ineffective, but most injurious. Opium has always been a favorite remedy with empirical and heroic practitioners, and we shall afterwards see that it is especially patronised by Dr. Seymour.

The milder cases of Pyrosis are said to be easily cured as follows:

"Gr. v of Pulv. Kino Comp. given three times in the day, and the bowels kept open by enemata or aloetic purgatives, speedily cures the disease, especially if combined with rhubarb, &c. &c. and a diet principally consisting of poultry, butcher's meat (once in the day), eggs, potted meat, curried food, and weak brandy and water as a beverage." (p. 10.)

Does the author give this diet as in any way peculiar?-We are glad to see, that in such cases he discountenances the use of "calomel and purgatives," informing us that, when so treated, they "became greatly protracted as to time and severity" (p. 10),-protracted as to severity! Under the date of 1843-4, he gives a case which is a very instructive one indeed. It was a case of stomach disorder in a lady, marked by vomiting, &c. "I repeatedly asked her if, by putting her hand on the pit of the stomach, she could discover any hardness or lump. The answer was: Certainly not." Some nine months after this she consulted Dr. Seymour again, with aggravation of the old symptoms, and with the addition of "an extreme sense of debility." To the same queries as to the state of the epigastrium, she replied as before:

"The patient became worse. About three weeks after this meeting, she had a fainting fit, and when summoned I found her in bed. This enabled me to examine the abdomen, and greatly was I shocked to find, not one tumour, but a number of tumours, varying from the size of a pigeon's egg to that of a hen's egg, occupying the whole epigastrium and the left hypochondrium-fungoid disease! I went home, resolving nothing should ever deter me from examining the stomach, especially before giving an opinion, in future.” (p. 12.)

The patient died of course. Now we cannot help expressing some surprise that Dr. Seymour should have waited till the year 1844 to learn the necessity of examining the abdomen in all such doubtful cases, or that he should not have here been "enabled" to do so, until he accidentally found his patient in bed. This is surely not the kind of lessons he taught his pupils when "formerly a teacher."

The following elegant paragraph introduces the subject of gall-stone; and we may say that it completes it also, as we have scarcely anything else on the subject, except references to two cases which seem to be introduced-the one to show that the author was "Physician to the Asylum for the Recovery of Health, in the year 1827," and the other to

record the unique fact of an old lady who to relieve pain "applied bottles heated to such a degree as to burn the muscles of the part." (p. 16.) Burn the muscles! Why, the bottle must have been not only red hot but solid or filled with solid matter, to retain heat sufficiently long to effect this.

"The next most obvious and most frequent case is where the pain in the stomach or at the scrobiculus cordis is indicative of gall-stone; either the passage of a gall-stone alone along the hepatic duct, the cystic duct, or the ductus communis; or even where there are a very large number of these concretions in the gall-bladder, so that, during the operation of digestion, any change made in its situation produces tension of the gall-bladder itself. The pain, in either of these cases, is similar. There is most violent pain at the scrobiculus cordis, shooting through to the back; pain as of grinding the part is felt. The pain is so intense that it appears absolutely impossible that it should long be borne ; nevertheless, the pulse is never quick, and often preternaturally slow, as 50 or 60 in a minute, rarely above the latter. Sometimes this intense pain is accompanied by vomiting, but not always. However severe, it ordinarily disappears suddenly, as if by magic, and the patient, allowing for languor, is nearly as well as usual.

"When the calculus has entered the duct, whether it gradually proceeds forward or falls back, the pain is succeeded by a greater or less degree of jaundice, which immediately marks the disease; then, of course, the excretions are pale, often as white as chalk, while the urine is of the colour of porter; and this state continues until the concretion escapes into the bowel. Still there may be obstruction from a gall-stone, and subsequent intense pain at the pit of the stomach, tingling or itching of the skin, vomiting, while the urine is of the natural colour, and the fæces with the usual proportion of bile. In this case the calculus is in the cystic duct" (pp. 14-5.)

In the next fifteen pages we have an account of chronic ulcer of the stomach, perforation of this organ, and hæmatemesis, all mixed and intermixed in so strange a manner that it becomes almost impossible to find out to what particular disease individual observations or individual remedies apply. Here, also, the author ventures to leave the only path he should attempt to tread, and gives us some general statistics respecting the degree of prevalence of perforation of the stomach in the two sexes. We are disposed to agree with him, however, in believing that "there is no preponderating difference in either sex as to predisposition to this terrible disease." (p. 30.)

In the middle of this discussion the author, more suo, breaks out into quite a different theme: here it is a discourse on "diet in general;" and though he says he can "scarcely help incurring blame" for his opinions, we must say that they appear to us the least blameable part of his book. With the common-sense views of the following extracts, we entirely agree, and have the more pleasure in transcribing them because they are really good English-and do not, we believe, contain more than a single grammatical error.

"Other persons insist, when living in London, and never quitting their arduous duties, that they are free from all impeachment of irregularity, provided, as they say, they only eat meat, beef, mutton, and poultry; never sweets, entremets, jelly, cream, and the like; never eat pastry, not even apple-pie, and live in a delightful dream of civic anchoritism. These persons take no exercise, sit up late, often in heated rooms; their hearty meal of meat overcharges their blood (happy had it been divided with a little fruit jelly, or baked fruit, or even the anathematised apple-pie); they get heated, feverish, pains in the joints, pains in