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tamination excites greater contraction of the minute arteries than the more watery blood which results from the large white kidney; and, further, it is pointed out that with the lardaceous degeneration of the kidney the walls of the minute arteries throughout the body have a tendency to undergo degenerative changes by which their contractile and resisting power is impaired.

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In reply to the statement of Sir William Gull and Dr. Sutton, that the morbid changes associated with the tracted kidney are the result of "causes not yet ascertained," Dr. Johnson maintains that, in the majority of cases, the renal degeneration may be traced, with a high degree of probability, to an excessive consumption of food and of alcoholic stimulants, either with or without gouty symptoms, but he has seen many cases in which the disease appeared to be a result of long-continued dyspepsia in persons of strictly temperate habits. doctrine is that the proximate cause of the renal degeneration is to be found in the excretion of abnormal products by the gland-cells, which, in the discharge of their excretory functions, undergo destructive changes. The renal degeneration, therefore, appears to be a result of the physiological function of the kidney as one of the main blood-purifying organs.

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X.-Chapman on "Neuro-Dynamic Medicine." 1

THE nature and cause of pain have long been subjects of anxious inquiry by physiologists and pathologists, but it cannot yet be said that the problem has received a satisfactory solution. Causa latet vis est notissima, and a sensation which is experienced more or less, at one time or another, by every human being, is almost inexplicable as to its origin. Regarding what is called its final cause-that is to say, the purpose for which pain appears to exist, or the object it is intended to accomplish-it is, of course, the warning it conveys as to the existence of danger, and as to the mode of obviating or escaping it; but considerations of this kind belong to the province of the metaphysician rather than to that of the physician, whose province it is to examine into morbid conditions only with a view to the alleviation of human suffering. Hence, in medical books, although pain is repeatedly referred to as a symptom of disease,

1 Neuralgia and Kindred Diseases of the Nervous System; their Nature, Causes, and Treatment; also a Series of Cases, preceded by an Analytical Exposition of them, exemplifying the Principles and Practice of Neuro-Dynamic Medicine. By JOHN CHAPMAN, M.D., M.R.C.P., M.R.C.S. London, 1873. Pp. 512.

very little information is given, or, perhaps, can be given, as to the essential nature of pain itself, further than that it is some condition of a nerve or nerves which is accompanied by a disaagreeable impression. If there were no nerves in the body there would be no pain, and on the other hand there would be no pleasure; but such remarks, again, belong rather to metaphysics than to medicine. The study of the nervous system, however, has led to such discoveries as to the respective functions and properties of different nerves as to reflect immortal honour upon the discoverers, and to place them upon the highest niche among the prominent benefactors of mankind. It is needless to refer to Sir Charles Bell, to Marshall Hall, and to BrownSéquard, as among the foremost in the ranks of those who have successfully cultivated the physiology of the nervous system; but when we turn from what has been written upon the function of healthy nerves, to the theories and speculations and practice which have been proposed in reference to the diseases of the nervous system, we become lost in perplexity when attempting to reconcile conflicting views or to connect the results observed with the original influences from which these results have sprung.

Dr. Chapman, as far as we know, has himself made no original physiological researches in reference to the functions of the nervous system, but he deserves great credit for the industry he has displayed in examining the results obtained by other investigators, both English and foreign, and for the diligence with which he has collected from a multitude of sources a great array of facts and opinions bearing on the subject of neuro-pathology. That his selection is always judicious we are by no means prepared to assert, and it strikes us that he often quotes from books and from authors whose opinions are not founded upon sufficient acquaintance with facts, but whose views, if agreeing with those of Dr. Chapman, are paraded with a prominence equal to that accorded to the great leaders of physiological and pathological science. So, again, if he deserves approbation for the persistent and laborious manner in which he collects pathological and therapeutical phenomena observed by himself; on the other dogmatic tone he assumes in maintaining his own views, the complacency with which he regards his own plans (or rather plan) of treatment, and the pertinacity with which he advocates, as

the

panacea

for human ills, in season and out of season, intra

professionally and extra-professionally, that special method of treatment which, to make use of the mildest expression, is still sub judice. Hence, among the general public, if we are to judge by the opinions expressed by the newspapers, he has met

with a reception in various quarters of the most opposite kind, some regarding him as the great discoverer of a plan of treatment in comparison to which all others are but empirical gropings, and others looking upon him as a modern Sangrado, who recklessly recommends only one kind of treatment for every conceivable form of human disorder. We consider him neither a William Harvey nor a Sangrado, and in the following review we hope to do justice to his theory and his practice, though we may be excused for sometimes questioning the validity of the one and the universal applicability of the other.

We must remark, in the first place, that although the word "neuralgia" is the prominent one in the title of Dr. Chapman's book, he includes a great many affections in his pages which, in the ordinary language of medicine, are not comprehended under that name. Indeed, he seems to use the word in its etymological rather than its medical sense, for he evidently employs it to denote any or all nervous pain, whatever may be its intensity, manifestations, or associations; and accordingly we find described among its predisposing causes its predisposing causes gout, rheumatism, cancer, pulmonary tubercles, and sleep (?); and among the exciting ones, teething and the diseases of the teeth, disorders of the bowels, piles, intestinal worms, uterine maladies, drunkenness, aneurisms, cancerous growths, enlarged glands, hernia, diseases of bones, syphilis, punctured wounds, the presence of foreign bodies, &c. &c. All these conditions and circumstances are or may be, of course, the causes, predisposing or exciting, of nervous pain, and we find no fault with Dr. Chapman for enumerating them, and our only object in pointing out the use made of them by the author is to show that the sphere of his inquiries and discussions passes far beyond the limits of what is known as "neuralgia" by the medical profession, and transfers the word to the category of general terms.

Having thus proposed for himself a very wide field of investigation, including, in fact, almost the whole range of medical and surgical pathology, it became incumbent upon him to investigate also the proximate cause of neuralgia, that is to say (adopting his wide definition of neuralgia) the essential nature and origin of pain in general. As he here enfers the territory of doubt and speculation, he, of course, also approaches that of controversy, and as in former writings he has given sufficient evidence that he is a spirited antagonist, so in the present volume he exhibits no falling off in that respect. He is, however, especially opposed to the views of Dr. C. B. Radcliffe and Dr. Anstie, which he vigorously denounces, inasmuch as he holds doctrines diametrically opposed to theirs. Both those physicians are honorably known by their writings or investigations on the

physiology and pathology of the nervous system, and although they have not, perhaps, solved the difficult problems presented to their notice, yet they have attracted attention by the ingenuity of their reasonings and the value of their suggestions as to the treatment of disease.

With regard to the genesis of pain, these physicians hold opinions which, though not identical, are in accordance with one another. It is not easy to represent their views in a very brief and, at the same time, intelligible form, because some of the experiments on which they rely are rather complicated in their details and some of their reasonings are somewhat recondite. But Dr. Radcliffe assumes that during each act of normal feeling there is an electric change in the feeling nerve and in the sensory centre to which it is related; that this change consists in a temporary reversal of the ordinary electric state of the nerve and nerve-centre in question; that this change is accompanied by a discharge or loss of "natural electricity;" that while this reversal exists the vitality of the nerve and nervecentre is lower than it is when the nerve and nerve-centre are not performing their function; that hence there is a diminution of the normal supply of arterial blood or of the circulation of venous blood in the nervous centres, or, in other words, that a lowering of their vitality increases their sensibility or irritability, and, therefore, constitutes the indispensable condition precedent of pain. The practical conclusion is that pain in general denotes a depressed condition of some nerve or nerve-centre, and Dr. Radcliffe points to the fact that pain of a neuralgic character may be associated with a very depressed condition of the circulation, and he considers, moreover, that such pain would seem to be antagonised rather than favoured by an over-active condition of the circulation.

in a

Dr. Anstie arrives at pretty nearly the same conclusion, but by a different process, and he puts forward the proposition that the nerve-centres of sensory nerves affected with neuralgia are state of atrophy, which is usually non-inflammatory in origin; and, with regard to various painful disorders, he maintains that pain is not a true hyperæsthesia, but, on the contrary, that it involves a lowering of true function; that its existence is due to a perturbation of nerve-force, originating in dynamic disturbance either within or without the nervous system, and that the susceptibility to this perturbation is great in proportion

to the

physical imperfection of the nervous tissue, until this imperfection reaches to the extent of cutting off nervous communication (paralysis). Dr. Anstie thus agrees with Dr. Radcliffe in regarding pain as being due to a lowered condition of

vitality.

Dr. Chapman, however, who, as he triumphantly announces, "fortunately holds in his hands a valuable instrument of experimentation and verification, which other labourers in the same field have not had the advantage of using" (p. 22), holds an opinion the very reverse of that supported by Drs. Radcliffe and Anstie. He does not entertain the slightest doubt that all functional disorder is expressive of material change; and although he admits that in some cases of neuralgia there are no visible evidences of morbid change at the seat of pain, yet he maintains that the seeming contradiction is easily explained by the fact that all pain is expressive of centric disease. In other words, he would argue that a pain-say of the eyebrow, or cheek— is due to some morbid change at the sensory root of the fifth nerve. The theory which Dr. Chapman believes " adequate to explain all the phenomena of neuralgia, which indicates a successful method of treating the disease, and the truth of which seems to be proved by the result of its practical application," is summarised in a series of propositions, which are as follows:(pp. 23 and 24) 1. Pain, whatever may be its exciting cause, and whatever may be the structure in which it is felt, is like ordinary sensation a phenomenon of functional change in the sensory centre into which the affected nerve is rooted. 2. The nature of the functional change denoted by ordinary sensation, and the nature of that denoted by pain, are essentially identical, the difference in the two being only a difference of degree of rapidity or intensity with which the change occurs. 3. Pain, like ordinary sensation, is of various degrees of intensity, and whereas pain denotes a more rapid functional change in the affected sensory centre than occurs during ordinary sensation, the successively higher degrees of intensity of pain are expressive of successively higher degrees of rapidity of functional change in the functioning sensory centre. 4. Whereas an indispensable condition of these functional changes in the sensory centre which are comprised within what may be termed the ordinary sensory scale is a normal supply of arterial bloodin order to provide for those transformative changes which are at once chemical and nutritive, and which constitute the groundwork and possibility of functional change, so a supply of arterial blood greater than normal is an indispensable condition of those more intense functional changes in the sensory nerve-centre comprised within the wide range of what may be called the neuralgic, or, more generically, and perhaps more correctly, the algic scale. 5. Pain is not necessarily a morbid phenomenon in its beginnings it is rarely, if ever so, in otherwise thoroughly healthy organisms; but if in such organisms, the operation of its exciting cause be long continued,

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