CLARK ON CONSUMPTION AND SCROFULA.

THOUGH not professing to offer the results of any new observa- tions, and modestly disclaiming any original discoveries, this work is an able and valuable treatise on a very important class of dis- eases. The author's studies embrace a wide range of writers both of ancient and modern date, especially those foreign physicians whose patient observations and researches into the morbid anatomy and pathology of pulmonary consumption have of late years rendered such essential service to science. Dr. CLARK'S Treatise, however, is something very different from a compilation. He has not merely mastered the knowledge of other men, but has

tested their opinions by the facts met with in his own practice in medicine and anatomy ; and if he has not—which we think he has—suggested from the discoveries of others a new mode of treatment, he at least deserves the praise which he aspires to, " of having placed the subject in a more striking point of view.' Perhaps, by basing practice upon principle, he will render the practice more successful, by as much as it is more specific and in- telligible.

The literary execution of the work is highly creditable to its author. The general arrangement and the different subdivisions of the matter are clear ; the facts are well-selected, and sufficient to illustrate the arguments without overlaying them ; and the ex- position of the more popular portions of subject is interesting. Save a few technicalities, the style is perspicuous, and, where the smatter admits of it, not devoid of a certain degree of elegance and force. For any tendency to diffuseness, the Doctor may perhaps allege the same excuse as fur his occasional repetitions—the wish to make himself popularly understood. Of the importance of the subject of the Treatise it is scarcely necessary to speak. Among the diseases to which the human frame is subject, those arising from tubercles are the most fre- quent and the most fatal. In temperate climates, they destroy a larger proportion of mankind than all other chronic diseases taken together. " In this country, and over the whole temperate region of Europe and America, tuberculous disease of the lungs causes probably a fifth part of the whole mortality ; and in some districts, and even in whole countries, the proportion is much larger." These tubercles are found in various organs, at every age. They have been discovered in still-born infants, and even in the foetus; and the number of children infected with them, dying between the ages of one and fifteen, has been estimated to vary from twelve in the hundred in the first year, to seventy-five in the eighth and thirteenth; though it should be observed, that in two-fifths of the cases tubercles were not the cause of death. When these particles are developed in the lungs, the disease is denominated phthisis (consumption); when " in the external glands and in the bones, it is commonly called scrofula ; and in the glands of the mesen- tery, tubes," &c. Incidentally, the whole of these disorders are touched upon in the book before us : but the most systematic and elaborate examination is bestowed upon consumption, in its origin, its progress, and its final stages: the first point being considered with a view to prevent, the second to cure, and the last to soothe. We will endeavour, as briefly as may be, to convey a view of Dr. CLARK'S opinion upon the origin of the disease, and to give a general idea of the contents of his book, leaving it for those who take a more peculiar interest in the subject to consult the volume.

There is no kind of doubt that consumption originates from tubercles in the lungs ; but the origin of tubercles has not been thought of, though, in the opinion of our author, by far the most important question. In treating pulmonary diseases as merely local, a cure may indeed be affected ; but whilst the constitutional disposition remains the same, the patient is constantly liable to a return of the disorder, which in the generality of cases may be said eventually, though still prematurely, to destroy him. Often, however, this affection does not openly develop itself till it is tco far advanced to be subdued by medicine.

In the highly-tuberculous constitution, tuberculous disease of the lunge very often steals on in a slow, insidious manner, making considerable progress before it manifests itself b any remarkable local symptoms, or its existence is even suspected by those who regard consumption as originating in inflamma- tory affections of the lungs. In such examples of latent tuberculous disease, an attack of catarrh, a slight inflammation of the pleura, or of the lungs, or hemop- tying, snot unfrequently the first circumstance which excites the attention or awakens the fears of the patient and his friends : and to this accidental occur- rence, to which the presence of tubercles in the lungs renders the person pecu- liarly liable, the origin of all the future mischief is attributed. I can readily unarm that an ordinary observer should arrive at such a conclusion ; and, as- cribing the disease to that which first presented itself to his notice, should con- sider the " neglected cold," the "inflammation of the lungs," or the "breaking tat a blood vessel," the original cause and source of all the subsequent evil. But, after the light which has of late been thrown upon the nature and diagnosis of tuberculous disease, it may well excite surprise that medical men should still regard these affections as the chief causes of phthisis. In a vast proportion of cues of this nature, a more minute inquiry into the patient's previous state of health would have led to the conviction that those affections were consequent

, or at least subsequent to the existence of pulmonary tubercles, or that

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had occurred in a tuberculous constitution, by which their effects were

tied. In another part of this treatise I shall have occasion to state the grounds upon which this opinion rests; and at the same time shall endeavour to show, that tuberculous disease of the lungs may be detected long before it gene- rally is ; that what is usually considered the early is in reality an advanced sale of the disease ; and that tubercle is a secondary affection, originating in a peed= morbid condition of the general system. This " morbid condition," which gives rise to the " deposition of tuberculous matter on the application of certain exciting causes, which have no such effect on a healthy system," is by Dr. CLARK denominated tuberculous cachexia. The symptoms of this distem- perature of humours at different ages, both in the hereditary and acquired disorder, are minutely enumerated in the work; but the results of the disease are said to be shown in an imperfect per- formance of all the functions of organic life. The secretions of the kidnies are disordered ; those of the skin are generally de- fective; the akin itself is often in an unhealthy state; and above all, the digestion is deranged : in other words, both the nutritive and excretory organs—the instruments by which food is assimi- lated to our various substances, and by which the useless matter Is thrown off—are languid or irregular. As might be anticipated, the nervous system is not unaffected, though it varies greatly in different individuals; being sometimes sluggish, but more fre-

quently preternaturally sensitive. After having pointed out the general state of the patient suffering under this di-order, and shown the symptoms by which

the practitioner may detect it, Dr. CL ARK proceeds to consider the

various stages and forms which tuberculous cachexia assumes when developed in the shape of consumption, and to detail the

particular symptoms by which it displays itself, and the physical signs by which it may lie detected,—as the manner of breathing, the sounds which the chest emits when struck by the operator, and the "respiratory murmur " from the lungs, heard either with the unaided ear or through the medium of the stethoscope. He next treats of the morbid anatomy of tubercles, and of the diseases which aWit d upon and complicate consumption. Some curious and valhOte statistical facts as to the duration of the disorder, its prevalsinie at certain periods of life, and its relative proportion as regards the sexes, ale then given ; together with the influence of climate and occupation in producing it, and its actual and relative increase or decrease. The causes of cachexia, whether hereditary or induced, follow ; as well as a view of the disorders which may determine it to the lungs. Besides an account of the existence and formation of tubercles in animals, and a slight notice of the curability of tuberculous disease, there is a popular chapter on the prevention of cachexia and consumption; and the work ciosea with an exposition of the medical treatment recommended by the author in both cases.

Into the minutia) of all, or indeed into any of these sections, this is not the place to enter, even had we room; but a few hints may be gleaned from the remarks on the origin and prevention of cachexia. According to Dr. CLARK, the disease is, or its seeds are, generally transmitted from the parents. In the case of a scrofulous constitution on both sides, there is little or no prospect of the child escaping it; if one parent be of a sound constitution, the child may inherit health from that one, especially, our author seems to think, from the mother. A variety of causes, however, may induce scrofulous affections when the parents are free from them, amongst the chief of which may be ranked indigestion ; though in the child they will be developed in various forms according to its constitutional powers, the strong rising to the dignity of gout or the disfigurement of cutaneous disease7--the weak degenerating into consumption. The leading principle of prevention in existing patients is resolved into strengthening the system, by regimen, rather than medicine ; little of which last is necessary even in curing the disorder, and that chiefly of an alterative nature. The moral of the whole book, as regards futu- rity, is to beware how you enter into the holy state of matrimony, and with whom. 1)r. CLARK is the MALTHUS of medicine, and would require the exercise of " prudential restraint," not from a regard to the means of living, but to life itself. We will close our notice with recommending the following judicious observa- tions to the reflecting public: for, if there be a state of pure misery in this world, it must be for parents to see their children drop off one after another without the power of saving them, and the conviction gradually forcing itself into their minds, that they are the cause of their premature death.

Were parents in general convinced that the health of their children depended chiefly upon the integrity of their own health, a beneficial effect might be pro- duced upon society at large, and especially on the members of strumous If a more healthy and natural mode of living were adopted by persons in that rank of life which gives them the power of choice, and if more consideration were bestowed on matrimonial alliances, the disease which is so often entailed. on their offspring might not only be prevented, but even the predisposition to it extinguished in their families in the course of a few generations. In the pre- sent state of society, it is needless to observe that the reverse of this very com- monly happens; and, from the total disregard of the circumstances alluded to, the race often terminates in the third generation. The children of dyspeptic persons generally become the subjects of dyspepsia in a greater degree and at an earlier age than their parents; and if they marry into families of a strumouc constitution, their offspring are frequently found to be scrofulous, and to die of consumption, or some other tuberculous diseases, in early youth, and even in infancy. I could adduce many melancholy examples of the truth of this obser- vation ; but it is at least consolatory to know that the evil may be obviated ; and it is a duty which parents owe to their offspring to endeavour to correct it. Members of families already predisposed to tuberculous disease should at least endeavour to avoid matrimonial alliances with others in the same con- dition ; but above all, they should avoid the too common practice of intermarry- ing among their own immediate relatives,—a practice at once a fertile source of scrofula, a sure mode of deteriorating the intellectual and physical powers, and eventually the means of extinguishing a degenerated race. " There can Le no question," says Dr. Mason Good, "that intermarriages among the collateral branches of the same family, tend more than any thing else to fix and multiply and aggravate hereditary predisposition. And hence, nothing can be wiser, on physical as well as on moral grounds, than the restraints which divine and human laws have concurred in laying on marriages between relations." It would also be well if persons contemplating marriage were aware of the neces- sity of attending to their health, previously to and after the adoption of this change of life. The dyspeptic should have recourse to such means as would re- store the functions of his digestive organs, and should adopt and adhere to a regimen calculated to prevent the recurrence of his complaint; the gouty sub- ject should renounce the well-known causes of his disorder; but those who are afflicted with organic disease, more especially with consumption, should pause before they enter in a contract which can only entail disease or unhappiness on all concerned. The full extent of misery arising from injudicious marriages of this description, is comprehended by the medical practitioner only : he will, therefore, appreciate the justness of these remarks, although he will acknowledge the difficulty of en- forcing the necessary restrictions on the practical consideration of the public. I am well aware that mankind in general are far too reckless to attend to any pre- cautionary measures on this subject, even although perfectly satisfied of their ex- pediency ; still there is a small proportion, in that rank of life to which the above remake apply with the greatest force, on whom these cautions may not be wholly thrown away.

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