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been followed up so as to yield material* each for a valuable work.— His use of splints to give tone to the debilitated extensor muscles of the upper extremities, furnished abundance of suppressed successful cases; and so did his thirty years' employment of the plaister bandage in sores of the lower extremities. By his versatile talents, in short, be saved live? enough to deserve to be decried by the gossips in ten counties round, as an experimenter on the sick.'
This volume displays throughout the ardent mind, inquiring spirit, and energetic but peculiar style pf the author.
Art. IX. Additional Cases of Gout, in farther Proof of the salutary Efficacy of the cooling Treatment of that afflicting Disease; with illustrative Annotations, written Authorities in its Support, controversial Disscussiona, and a View of the present State and future Prospects of the Practice. By Robert Kinglake, M. D* &c. }!vo. pp. 412. 8s. 6d. Boards. Murray, &c. 1807.
A Bout four years have now elapsed since Dr. Kinglake published his volume on Gout, in which he promulgated a new theory of the disease, and deduced from it a new plan of treatment. The thtory was that gout is a local affection, not necessarily connected with any constitutional disease, and that gouty inflammation is in every respect similar to inflammation brought on in the same part by any other cause; the practice recommended was, that the removal of the gouty inflammation is to be trusted entirely to the external application of cold. To the hypothesis we objected as being contradictory to obvious and well established facts j and to the treatment we demurred, partly in consequence of its being founded on a false theory, and partly because it was opposed to the uniform experience of those authors whose judgment we were most disposed to respect. At the same time, we exclaimed against the style in which Dr. Kinglake conveyed his ideas to the public, as being singularly pedantic and un» intelligible.— Notwithstanding these weighty charges, however, we admitted that his work, or rather the controversy to which it gave rise, might be eventually productive of some utility; for, although several among the most enlightened of the modern physicians, particularly Dr, Heberden, had clearly and forcibly pointed out the errors of the popular doctrine and practice, yet the sentiments of this judicious writer were not so generally disseminated as their importance required, and indeed were probably unknown to a large proportion of medi? cal practitioners.
In this point of view the subject appeared to us when we formerly brought it before our readers, and this is the light in
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which we are still disposed to consider it. The author has indeed now presented us with a large 8vo. volume, containing testimonies to the safety and advantage of the new practice, from a great variety of medical practitioners, and from those who have been thrmselvrs sufferers by the disease; besides a considerable number of cases which have fallen under his own observation. All these, as may be supposed, terminated favourably ; and both physicians and patients are strongly impressed with the wonderful efficacy of Dr. Kinglake's new plan: but we are still so obstinate as to retain our scepticism respecting its propriety, and still more with regard to the rheoTy with which it is connected. The Dr. may perhaps be surprized at our infidelity, and may be desirous of knowing on what grounds we can maintain it. We shall therefore State them as briefly as possible.
We rest our objections both on general and on particular considerations. First, we m.iy observe that, although the propriety of any medical practice is ultimately to be decided by an appeal to fact, yet the mere relation of successful cases, or the strongest assertions of the practitioner, are not sufficient to produce conviction. Before we can place implicit confidence on these statements, we must be certain that the relator thoroughly understands the subject on which he treats, and that his mind is not under the impression of any undue bias. Though it may appear strange for us to suppose that Dr. Kinglake should be ignorant of the nature of gout, yet we cannot avoid remarking that he writes very much like a person who is unacquainted with it. Gout is a disease which, according to every definition of it that has been proposed, and every, description of it that has been written, consists of a combination of general and local symptoms. Now, when an author directly asserts that constitutional symptoms do not form any pait of the complaint, what conclusion are we to draw? We are under the necessity of inferring either that the s id author is ignorant of the nature of the disease, or that he designedly deviates from the nomenclature which is generally employed. As we have here no intimation of this latter circumstance, we are unavoidably led to recur to the supposition that, eithtr through a want of accuracy in his method of making observations, or from some other cause, Dr. Kinglake is not thoroughly informed of the nature of the disease on which he has written. Even supposing that we are not warranted in this opinion, and admitting that all medical writers previous to Dr. K. have been mistaken,—not about an opinion, but about an ohyious matter of experience,—we have next to inquire whether his mind is in such a state as to enable him to form, a
correct. correct judgment respecting the value of the new method of practice. This we will venture to assert is not the case; for instead of those qualities which characterize the candid and patient inquirer after truth, we find him employing the utmost , dogmatism of language, violently declaiming against all those • who differ from his decision, and denouncing them as willfully clinging to error and shutting their eyes to the light of truth and reason. Such lofty pretensions always excite our suspicion, and lead us to scrutinize, with more than usual severity, the grounds on which they are built. If we find the foundation fragile, we of course lose all confidence in the writer who endeavours to force our judgment when he cannot win it, and to crush an antagonist whom he is unable to confute.
Another feature in these cases adduced by Dr. Kinglake gives them a suspicious aspect, viz. the uniform success of their termination. From the beginning of the book to the end, we find no untoward accidents, no disappointments, no obstacles. This is unfortunately so different from the common occurrences of medical practice, that we involuntarily refuse our assent. We would not indeed insinuate that the author has published a set of fictitious narratives, but we fear that he has frequently given too easy credit to that which seemed to support his opinion, that his imagination has often led him to overcharge the picture, and that in his haste to arrive at the conclusion he has neglected to notice the intermediate stages.
The considerations which we have urged will, we apprehend, appear to many of our readers to afford just ground for withholding our credence in Dr. Kinglake's doctrine, viewing it on general grounds; and if our limits permitted, we think that we could prove that an examination of the individual cases would not be more favourable to it. We should find almost the whole of them narrated with a remarkable want of precision •, we should meet with many very simple occurrences magnified into amazing cures; we should perceive that many of th* cases were certainly not gout; and we should observe that in very few of them has Dr. Kinglake, or have his correspondents, taken notice of those symptoms which are almost as essential tovthe constitution of. the disease as the local inflammation. Besides, a considerable number of the cases are related, not by the medical attendant, but by the patient himself; a kind of evidence which every practitioner knows how to appreciate: for, strange as it may appear to the unprofessional, in many instances a man's testimony respecting himself in sot equally worthy of reliance with that of another person.
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To the cases are affixed copious annotations by the editor, in which he corrects the errors of his correspondents, points out the occurrences which are particularly illustrative of his theory, Or enters more fully into its developement. As far as we can penetrate through the cloud of words, it appears to ns that the Dr. has in no Tespect swerved from his former opinion concerning either the nature of gout or its treatment. We do not observe any alteration in his style: but it is still marked by a degree of turgescence and pomposity that is truly ludicrous, and which perhaps was never before found in any work not written professedly as a caricature. With more regret, however, we perceive that Dr. Kinglake yet retains the same arrogant assumption of his own merits, and the same supercilious contempt of his opponents. The letters of his correspondents are indeed but too well calculated to keep alive this spirit; since they lavish on him all the stores of flattery, dignify his speculations with the mast excessive commendations, and consider the application of cold water to gouty inflammation as a greater discovery than that of the Vaccine Inoculation.
In justification of our censure, and to afford our readers some amusement, we shall quote a few passages from Dr. Kinglake's volume. The first sentence of the work may be regarded as a specimen of that comfortable state of mind, which is experienced by those who are not blind to their own merits:
* The effects of the cooling treatment of gout have already proved so highly beneficial to the sufferings of the arthritic part of mankind, that the practice promises soon to become unequivocally established, and to number among the most important improvements in the management of disease. It has had indeed to contend against much and various opposition, but this is no more that what has been uniformly experienced by every attempt to introduce a radical innovation into any part of the practice of medicine.'
In the ensuing paragraph, we have some of the leading features of the author's doctrine, and a proof that his present opinion coincides with his former sentiments:
* The strong analogy subsisting between an inflammatory affection of the ligamentous and tendinous structure from sprain, contusion, and incision, and that which arises from arthritic or morbid excitement from various partial and general conditions of vital power, irresistibly identifies itself in comparing the relative symptoms. The local paia« its indefinite continuance, and the systematic irritation it occasionally induces, are common to both, and are in fact often vndutinguishablj similar. Gout occasionally so far disorders the general heatth as to produce spasmodic affection of the stomach and other viscera; sprafn dofs the same, and indeed not unfrequently goes the length of in. during locked jaw. By heating treatment they are both aggravated and prolonged j by cooling applications, promptly relieved and cured.'
We shall nest present our readers with a sample of Dr. K.'s declamation:
* As long as the principle of heat is transmissible from one substance to another, and by natural law irresistibly seeks an equal distribution, its concentrated accumulation in inflammatory diseases must ever be scattered and diffused by the topical application of substances at a lower degree of warmth.
'This is so evidently the case that common sense will ever admit the fact, and be directed by it in rejection of all the laboured abstruseness of scholastic jargon, of all the visionary subtleties of casuistic refinement, against its simple but efficient validity. The respectable author of the preceding case is led in his scientific speculations by the clear evidence of facts, is proof against sophistry, superior to prejudice, and rationally open to the conviction t>f his senses. His chaste philosophy has taught him the eternal verity of the axiom, nihil est in inleflectu quod non priut fuerit in sensu, and from this only correct source of reasoning flows hts intelligent persuasion of the curative power of topical cold in gouty inflammation. It may be presumed that neither the snarling of the cynical, the clamour of the invidious, tlje dread of the timid, the ptrtinaciousness of the prejudiced, the devotion of the bigotted, nor the calumny of'the malevolent, against the cooling treatment of gout, will prevent the liberal advocates of truth from ultimately establishing the practice.'
One more quotation of the same kind will probably be deemed sufficient:
4 These cases afford incontrovertible evidence of the curative power of topical refrigeration, in what is commonly denominated inflammatory rheumatism. Such instances of local disease, under the usual management, generally endure many weeks, often indeed months, and not unfrequently leave irreparable mischief, both on the affected joints and on the system at large. Is not then an early removal of agonizing torture, and the protection of the general strength from its depredating violence, an important benefif? What advantage cam accrue to the deplorably neglected patient in the accustomed treatment, from unmitigated and indefinitely protracted pain? Is either the immediate or distant health amended by such tolerant indulgence of disease? If not, will medical practitioners knowingly and deliberately continue to be medical tormentors? Will they still remain hoodwinked by prejudice; still persist in the strait course of deceptions custom, and never deviate from the beaten track of error, to improve their practice and alleviate the sufferings of mankind? Inveterate delusion! Is it sanctioned by long usage, or upheld by mistaken views of correctness? On whatever authority it may rest, let its vafidity be fairly tried by facts, by those natural occurrences which de. terming the truth ia all contested and ambiguous opinions. To imagine