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Dr. Forbes in Reply to Mr. Newnham on the Present Aspect of MedicineAuthor(s): John ForbesSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 12, No. 14 (Jul. 12, 1848), pp.371-374Published by: BMJStable URL: http://www.jstor.org/stable/25500405 .

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THE PRESENT ASPECT OF MEDICINE. 371

CONCLUSIONS:

1. In animals belonging to the class of Articulata,

Complete local and limited anesthesia can be produced

by the local and limited application of the vapour or

liquid of chloroform to individual parts of the body of

the animal.

2. In Batrachian reptiles, the tail, or an individual

limb, can be affected in the same way with local

aneesthesia, by the local application of the chloroform;

but, in addition, general anesthesia of the animals usually results in a short time, in consequence of the chloroform

absorbed by the exposed part coming to affect the general

system. 3. In the smaller Mammalia a singlelimb, or even the

whole lower or pelvic half of the body, can be rendered

anaesthetic by local exposure of these parts to the influence

of chloroform.

4. In the human subject partial, and, perhaps, super

ficial, local anaesthesia of a part, as the hand,' can be

produced by exposing it to the strong vapour of chloroform; but the resulting degree of this local

anaesthesia is not sufficiently deep to allow the part to

be cut or operated upon without pain. 5. Any agent possessing a stronger local benumbing,

or an anaesthetic influence, would probably be dangerous, by its acting too powerfully on the general economy, before the local anaesthesia was established to a depth sufficient for operating.

6. Artificial local aneesthesia, from any known anaes

thetic agents, seems objectionable in any part intended

to be operated upon, in consequence of the vascular

congestion and injection which attend upon and accom

pany this local anaesthesia.

7. There are few operations in which there is not pre

viously a local broken surface; and the application of

chloroform, &c., to such a surface, would be far too

painful to be endured, no small degree of suffering sometimes arising from even the exposure of the un

broken skin to their action.

DR. FORBES IN REPLY TO MR. NEWNHAM

ON THE PRESENT ASPECT OF MEDICINE.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND $URGICAL JOURNAL.

SIR,-I hope I am sufficiently tolerant of criticism

to feel but little concern at anything depreciatory that may be said of my humble writings by the

public press; and I am too careless and indolent to

notice statements that merely relate to me personally. I would not, therefore, have troubled you or your readers with any remarks on the long paper of my friend Mr. Newnham, now brought (as I suppose,) to a

conclusion in your pages, had I not felt, that by so

doing, I might possibly, in some little measure, pro. mote an object of professional importance. What I

now propose to say, while it corrects some mistakes

into which my friend has fallen, may have the effect of

selling the attention of your readers, still more closely,

to Mr. Newnham's excellent paper, and thereby aid

the great cause which we have both so much at heart

the real advance of medical science and practice.

Of the numerous contributions and remarks, public and private, from personal friends and unknown critics,

which have been called forth by the article commented

on by Mr. Newnham, none has been, on the whole, so

satisfactory to me as the paper in your Journal. Putting

entirely aside the compliment implied in the fact of

Mr. Newnham thinking the article of sufficient import ance to call for so elaborate a commentary, I cannot

help feeling particularly gratified to find a man of such

long and extensive experience, and of such acknowledged

talents-and, moreover, a general practitioner,-record

ing his concurrence in most of the views, both scientific

and practical, contained in that much-discussed paper. And my gratification is not a little enhanced by the

circumstance, that Mr. Newnham's concurrence in my

opinion has been, as it were, forced upon him by the

strength of his convictions-through the honesty of

his nature and his paramount love of truth-in

direct opposition to his obvious predilections and

prejudices. My friend's first impressions on reading the

article, were evidently unfavourable to my views; and

he took up his pen in a hostile, or at least in an

antagonistic spirit, to battle for what he deemed

the truth imperilled, as he thought, in my unlucky

pages. But Mr. Newnham is not the first man who,

in combating a supposed heresy, has himself been

converted, or who, on a holier occasion, having gone

to scoff remained to pray. In making this statement,

I am far from claiming the credit of converting my friend by my arguments: I am quite content with the

honour of having supplied Mr. Newnham with the

occasion of reviewing in his own mind, in a more parti

cular manner, the results of his own observation and

experience. The consequence to a man of his acute

ness and candour, was inevitable.

It is indeed true that, while assenting wholly to

several of my principal positions, Mr. Newnham only

partially agrees with some, and dissents altogether

from others; it will be found, however, that, even in

regard to these latter, or at least to several of them,

the difference between us is much widened, and in

some cases entirely created, by a misapprehension on

his part, of my meaning. In taking up my pen, I at

first intended to restrict myself to the correction of

some of these mistakes of my friend; but I now feel

unwilling to let slip so favourable an opportunity of

strengthening my cause, by the very effective, though

unintentional aid of so doughty a champion as Mr.

Newnham.

Mr. Newnham makes a strange mistake in confound

ing what is termed in the article, "The N atural History

of Disease,' with the plan or plans of treatment

advocated in it. Nothing could be further from the

truth than this; and I cannot see how Mr. Newnham

could have made the mistake. Throughout the whole

article, the Natural History of Disease is merely

spoken of as 'a thing of essential importance to be

known, with the view of regulating practice; b

nowhere is it contemplated, much less recomm

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372 THE PRESENT ASPECT OF MEDICINE.

that any kind of rational treatment should be super. seded by the process of mere observation or study of, the phenomena of disease. This study is inculcated

as of 'paramount importance for the attainment of

rational practice-not as an equivalent or substitute

for practice: to do so would be a palpable absurdity. Mr. Newnham states very accurately the views of the

author of the article, when he says,-" If, by attract

ing attention to the natural history of disease, the pre scriber may be alienated from an exclusive attachment

to drugs, and can be led to a profounder study of

regimenal and hygienic treatment, good must arise."

In like manner, Mr. Newnham seems to assume,

throughout his paper, that the author of the article is

an exclusive advocate of what has been termed the

expectant system, in all its unmitigated severity,--that

is, of a system which leaves nature, in the cure of

diseases, jptirely to her own resources. This is an

equally great, if not precisely the same, mistake, and

one which assuredly finds no sanction in the article

in question; on the contrary, the only form of expecta tion contemplated in any case, when contemplated at all,

was that form of it inculcated by STAHL, in the curious

little work in which he criticised Gideon Harvey,

entitled, "Ars sanandi cum Expectatione, opposita Arti sanandi nuda Expectatione,"-a system which, so

far from leaving things entirely to nature, authorises

and inculcates the employment of all therapeutical

measures, medicinal as well as regimenal, energetic as

well as mild, whenever and wherever aproper indication

exists; and only advises non-interference in the very Tare case where no such indication can be found, and

in which neither reason nor experience can suggest

aught that promises advantage to the patient: and, in

truth, Mr. Newnham himself seems inclined to go as far

in this direction as the author of the article. His de

scription of the expectation here put hypothetically as what he could sanction, is precisely that entertained

by myself, and, as far as I know, by all those who pro fess to follow Hippocrates, Stahl, Sydenham, or others

who have professed and practised a rational expectation. "If by expectation," says Mr. Newnham, "be really intended observation, on the course of the malady, and

supplying the proper remedies which such watchful

ness may indicate, only in such order, and in such

doses, as shall most safely lead to the convalescence

of the patient,-accomplishing this object by the mildest

known efficacious remedies, and attending diligently to all the beneficial influences which may be conveyed

through the moral nature of man, as well as to all

similar impressions conveyed by attention to diet and

regimen, and air and quiet, and the general proper

management of a sick room, why, this is only to

abstain from that which would be a positive hinderance

to nature's agencies, and here we go hand in hand

with our expectant physician."-(p. 200.)* And Mr.

* "But this (Mr. Newnham adds) " will not satisfy him, because this would involve the employment of every remedy calculated to four our object, and assist nature in the

accomplishment of her views, and assuredly this would be to

ipterfere,wji the natural history of disease,"-as if any sane

physician ,ould hesitate to interfere, where he saw room iI te^%erence, merely that he might study the disease !

Newnham's concurrence in this rational and praise.

worthy abstinence in treating disease, is declared in

almost every page of his paper. Assuch sound doctrines cannot be too much impressed

upon the minds of practitioners, especially the younger members of the class of general practitioners, I hope you will allow me to transcribe, in this place, a few more of

my friend's statements bearing on this point. I shall set them down just as they catch my eye, and without par ticular comment. "V We shall admit the vis medicatrix

nature ;-we shall admit that nature ever tries to restore

all manner of lesions in her economy;-and we shall

admit that it is folly and madness to contravene her

efforts."-p. 198. " So again, of specific disorders

measlesfor instance; this must run a definite course, and

if it be a mild case, it does as well under the marigold tea

of the old woman, the handmaid of nature, as it does

under the influence of more powerful articles of the

Materia Medica."-Ib. " We cheerfully admit that the

greater number of acute maladies pass of themselves

through successive periods of incubation, gradual

development, highest degree of intensity, decline and

convalescence, without the employment of active

remedies."-p. 199. " It is perfectly true that medical

persons often gain credit for cases which nature has

performed."-p. 253, &c., &c., &c.

The following extracts place in a very satisfactory

light Mr. Newnham's coincidence with the views of the

author of the article, respecting the use and abuse of

drugs: " It is equally the fact that medical men, as they

become older, become more distrustful of results; the

enthusiasm of their early years is abated, and they become less ' heroic' in their prescriptions, more

trustful of nature, less cofffident in themselves."-Ib.

" We are fully disposed to admit that the treatment

of disorder by medicine is often inefficacious and some

times injurious; nay, we may believe with Dr. Forbes,

that the rapid cure of some patients under hydropathic or analogous treatment, may depend upon their abandon

ment of injurious medicine."-p. 255. "We are not

prepared to say that much of the practice in the

present day is not mere guess-work, especially with

those who see their patients perhaps but once, or, at all

events, at very distant intervals."-p. 282. " We dis

like polypharmacy as much as it is possible, and we

would never exhibit a remedy of any kind unless we

had a scientific reason for so doing."-lb. " We

quite agree with our author that much good may be

done by abandoning the heroic method of treatment,

provided that it be not supplanted by that system of

negative expectancy, &c."-p. 283. " We believe that

mischief perpetually arises from administering powerful remedies in large doses; we believe that irreparable evils accrue from the uncalled for exhibition of purga

tives; and that much injury is occasioned by this

perturbing system, by this thoughtless administration

of drastic poisons."-p. 282. " There are great errors

in the present day, and in the present style of pre

scription; and much as we abhor the system of being

paid for medicine, much as we think it odious and

intolerable, there are advantages in this system which.,

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THE PRESENT ASPECT OF MEDICINE. 373

are forfeited by others."-p. 283. "One word upon

mercury. We believe that the use of this remedy is

often inordinate-often misplaced-often mischievous.

We have been saturated usque ad nauseam, by the

public and by medical consultants, with the reference

of every form of gastric and intestinal malady to

bilious derangement; and that too, as a direct conse

quence of some primary irritation of the liver. We

have been grieved with the eternal and mischief

making prescription of calomel and blue pill, and

grey powder, for ever and aye, where mercury in every form should have been religiously withheld."-Ib.

"We are quite willing to admit that, in general, we

may be too little attentive to diet, regimen, &c., and

that medicine loses much of its power by being deprived of the aid thus afforded."-p. 284. " Most devoutly do

we wish for the daywhen all medical practitioners shall

be paid for their time and talents, and not by the

amount of medicine which has been exhibited."-p. 181,

&c., &c., &c.

Now, I flatter myself that, in these extracts, my friend Mr. Newnham, shows himself a worthy and

vigorous son of "Young Physic ;" and he will forgive

me, on account of the motive, for thus placing some of

his excellent opinions in closer contact than they exist

in his paper. It is but justice to him, however, to

state, that these admissions and confessions on his

part, are, in the original paper, qualified, in many

cases, by subsequent observations intended to show

that the views of the writer of the article are different

from his, Mr. Newnham's. He may therefore say, that, in one sense, the extracts are "garbled;" but I

shall not quarrel with his doing so, so long as he admits

his opinions to be as here recorded; and this I know he

will not hesitate to do. Most of his subsequent quali fications (here omitted,) are founded on that misappre hension of my real views respecting the treatment of

diseases, already referred to. For the fair but feeble

exposition of these views I confidently refer to the

article criticised; of their truth and justice, when

taken with the qualifications that accompany them in

the original, I am more and more convinced by every day's additional observation and experience; and, as I

have already said, it is most gratifying to me to find

that I may add Mr. Newnham to the long list of men

of the first eminence in the profession, who have been

pleased to express their approbation- of them both

publicly and privately. I am ready to admit that,

owing to the hasty manger in which the article was

written, and to the impossibility, for want of room, of

developing, with equal fulness, all the parts of the

subject, some passages in it, taken by themselves, may

appear too strong, and a few may even seem to bear an

interpretation quite different from that they were meant

to convey. But the views there delivered, when fairly

judged, I can neither retract nor qualify; and I take

the liberty to say that they are such as no physician who has a proper estimate of his profession, need be

ashamed to avow.

So much for the general subject of Mr. Newnbams's

comments and animadversions: but before I conclude,

you must allow me to occupy a little more of your

space while I refer to some other passages in which he

-has as completely mistaken my meaning. As, how.

ever, these are chiefly of a personal character, and

consequently less important, I shall notice them as

briefly as possible. Mr. Newnham, " while cheered to find that I am.

not a believer in homoeopathy," is still very wroth

with me for dealing so leniently with Hahnemann

and his system. I am surprised that so experienced a

controversialist as Mr. Newnham did not recollect, what

he must be well aware of, that the antagonist who is

candid and courteous with his opponents, is much more

likely to meet with success in the combat, than one

who misrepresents them, or refuses them every sort of

merit. Had I been in any way a favourer of home

opathy as a system of doctrine or of practice, I should

not have been made the object of so many printed attacks from the homceopathists themselves, on account

of the article in question. Speaking of the circum

stances on which Hahnemann says he originally founded his system, Mr. Newnham most strangely states that I " allow them all the force of facts," and

consider them " as good evidence as what can be

adduced in favour of any other medical doctrine." So

far from this being the case, I formally deny in the

article the truth of those circumstances altogether. I

merely say that "c we have no more right to reject the

evidence supplied in its favour by its professors, than

we have of rejecting any other evidence." Of course

not: but then the evidence must be true evidence, and

equally good on both sides; and this I deny, in regard to homoeopathy, over and over again, in the same place.

Mr. Newnham further says, (p. 228,) " that Dr.

Forbes admits the claim of the doctrines of homceopathy to be founded on grounds even superior to reason,

experience, and experiment." Now, I most assuredly admit no such thing. At p. 232 of the article, I cer

tainly say, "So far, it must be allowed, the doctrines

of Hahnemann have either a show of reason in them

selves, or, at least, claim to be founded on grounds even superior to reason, experience, and experiment." But it is one thing for a party to claim and another to

have the claims admitted. Mr. Newnham might just as well say, that because I allow that he claims for

mesmerism certain powers and privileges, therefore

that 1 admit the reality of these powers and priveleges.

Many other portions of Mr. Newnham's account of

my opinions respecting homeeopathy are equally incorrect. He goes all along on the assumption, that, because I refuse to the crude inferences of mere post hoc reasoners, the right to be regarded as fair evidence, much less as proof of the powers and virtues of many common drugs as commonly administered; and com

pare, in this respect, the case of homoeopathy and ordi

nary medicine; that I therefore admit, as a general trutA, that the evidence in favour of each is equal, and con.

sequently, that we must either believe both, or reject

both, in toto; and, as I attribute all the cures in home

spathy to nature, I must likewise attribute all the cures

in ordinary practice to nature also I Nothing is more

unfair,-indeed, more absurd, than such an assumption.

Any one who reads my article carefully will see that

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374 POISONING BY ARSENITE OF COPPER. I rigidly restrict my comparison with homeopathy to common blind routine practice, and do not at all'

extend it to rational or scientific practice; that I*

restrict it to the proceedings of the ignorant and ill

educated, to the exclusion of those of the scientific, learned and judicious. In like manner I compared

Hahnemann and his system with other theorists and

systems,-with Paracelsus, Stahl, Silvibs, Brown, &c., and their visionary theories; not with the men and the

doctrines of the modern Hippocratic school of observa.

tion. An examination of my paper will shew that such

alone was my meaning and intention, and numerous

passages might be quoted from it to prove this. If this

was not my intention, what could I mean by such

passages as the following ?-"We hold the great

alleged fact from which the doctrine took its rise, to be

no fact at all."-Art. p. 234. " We affirm that a large

proportion of the experiments performed by Hahnemann

and his friends, with the object of ascertaining the

therapeutic properties of medicines, are altogether fallacies."--lb. " In making these admissions in

respect to the instances of treatment supplied by Drs.

Fleischman and Henderson, we wish formally to guard ourselves against being supposed to admit, at the same

time, as if it were one and the same thing, or as if one

were a corollary of the other, that the result of the

homoeopathic treatment generally, is, and will be, as suc

cessful as the result of the ordinary treatment generally." -p. 250. "In doing so, [i. e., adhering to the ordinary medical practice,] we consider that though we are

embracing a system extremely imperfect, we are at least

embracing one which, with all its faults, contains a con siderable amount of truth, and a yet greater amount of

good; and which, above all, is, or may be made, in its

exercise, consonant with the principles of science, and is capable of indefinite improvement; while, in rejecting homoeopathy, we consider that we are

discarding what is, at once, false and bad-useless to the sufferer and degrading to the physician."

p. 2,56-" From these our free confessions and bold

denunciations of the feebleness and uncertainty of

therapeutics, it may possibly be inferred, that we

are entirely sceptical of the truth of medicine as

a science, and think most meanly of it as a practical art. And yet this is not so; on the contrary, we

look upon medicine, regarded in all its parts and

bearings, as a noble aad glorious profession, even in

its present most imperfect state, and we believe it

destined to become as truly grand and glorious in

actual performance, as it now is in its essence, its aims, and its aspirations."-p. 260. " In the hands of men

of scientific education,-men of philosophical views

and long experience, and who, from the position they

occupy, and the confidence they inspire, are enabled

to proceed exactly as they think best, PRACTICAL

MEDICINE, we readily admit, is, even now, a rational

and wise system, rarely productive of evil, if it fails to

benefit, and often benefiting in the highest degree.--.b. " Such as it is, our project of reform is, at the least, a, conservative as radical. We are not altogether dis

contented with the general principles on which medicine, considered as a science, is now studied, by many men

pf education; we do not object greatly to the mode in; which we know it to be exercised, as an art, by many of its professors; but we cannot shut our eyes to thie enormous mass of its defects, &c."-p. 261.

There is only one other statement of Mr. Newnham's

to which, before concluding, I must refer; but being one entirely personal, I shall notice it very briefly.

Throughout his criticism, Mr. Newnham speaks of my article as if it were a separate work, calling it " the

pamphlet," and asks, somewhat indignantly, "Why are the public invited to study this subject! Why are

they tempted by alluring newspaper advertisements and a catch title, to dive into these hidden things !" Now, the fact is, that the article in question was never pub lished at all, except in the pages of the British and

Foreign /Medical Review. A few copies were struck off

separately, and sent to the author's personal friends,

accompanied by a printed note,requesting them to favour

him with any remarks that might occur to them; but not

one copy was sold,or offered for sale. In all probability I sent a copy to Mr. Newnham, as one of my personal

friends, and this he may have taken as evidence of

separate publication. I am, Sir,

Your obedient servant, JOHN FORBES.

Old Burlington Street, June 28, 1848.

CASE OF POISONING WITH ARSENITE OF

COPPER; WITH REMARKS.

By JOHN M. BRYAN, Esq., Surgeon, Northampton.

On Wednesday, June 7th, at a public dinner, attended

by about forty persons, Mr. William Cornfield, aged 62, .with six or seven others, partook of some blancmange, coloured with emerald-green, among other eatables, at

the New Hall at Northampton, the dinner being sup

plied by Mr. Franklin, confectioner of this town.

According to the evidence of the widow, Mrs. Ann

Cornfield, the deceased left home about half-past ten in

the morning. He appeared quite well when he left.

He returned home in an omnibus about half past six

in the evening. He was very sick directly he came

home; he had a little tea and a little brandy gruel after he was in bed. He also had some tea about one

in the morning, and the sickness left him and he went

to sleep. About four in the morning he awoke, having been asleep since one or apparently so, and said that.

although better he was still very bad; she went down

stairs to procure him some tea, and was gone about

,twenty minutes, and on her return he was quite dead.

No medical assistance was called in thinking it was

only the different articles of food taken at the dinner

that had caused his illness. He did not complain of any pain; when he returned home he said that the

sickness was caused by some jelly or blancmange he

had eaten at the dinner. He was perfectly sensible to

the last. He had three motions after he came home

and vomited five or six times. The first time the matter

vomitted appeared very greasy, the second time it was

rather yellow, and after, the brandy it was darker. He,

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