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One of Mr. Abernethy's earliest publications was, "An Essay on the Functions of the Skin," which originated in the inquiries and important discoveries of Doctors Goodwin, Priestley, Ingenhouze, and others, relative to respiration and its reciprocal connection with the functions of the skin. Much credit is due to the author of this Essay; and I am induced more particularly to allude to it ou account of its bearing on that most interesting and intractable disease, pulmonary consumption. After a variety of ingeniouslydevised and cautiously-conducted experiments, Abernethy came to the conclusion that there is a similarity in the nature of the matter exhaled from the lungs and from the skin of the human body; and that, to a great extent, their functions are reciprocal. Thus, he says, "the similarity of the office performed by the skin and the lungs, explains, in my opinion, many circumstances, observable in the causes and cure of pulmonary consumption. The people most liable to such complaints, are those whose constitutions are feeble, and whose chest is of scanty dimensions. If the cutaneous perspiration of weakly people be checked by exposure to cold, it is tardily restored to its former state; the constriction, which exists on the surface of the body, is with difficulty overcome, owing to the deficiency of power in the heart and arteries. The consequence will be, a plethoric state of the vessels; from a retention of that great quantity of matter which ought to be emitted from the surface. For the relief of this plenitude, other discharges will be substituted. Common experience informs us of this fact, that weakly people readily (as it is expressed) 'take cold;' the consequence of which is, discharges from the nostrils, the bowels, or the lungs. But if people of vigorous health accidentally suffer any constriction of the cutaneous vessels, the internal powers possess strength to remove it, and to propel again the fluids through the exhalants of the surface.
"When perspiration is diminished, the determination of fluids to the lungs is particularly to be expected; because the copious secretion from those parts will relieve plethora, and because that secretion is similar to the one which has been suppressed. The blood will become surcharged with air, to which the lungs only can afford an outlet. It is as much to be expected, that, when perspiration is suppressed, the office of the lungs will be increased, as that performed by the kidneys: by means of the latter, the blood is freed from the superabundant water; by the former, from the retained air.
"Thus, an accumulation of fluids in the pulmonary vessels will ensue, which will be more considerable, and more likely to produce disease, when the thorax is of scanty dimensions, and the transmission of blood through the lungs, in consequence, difficult. This plenitude of the arterial system, in the lungs, probably will produce inflamillation; the degree of which will vary, as the exciting cause and constitution of the patient determine. I am inclined, on reflection, to believe that a deficient performance of the functions of the skin is the principal cause of pulmonary consumption.
"This supposition explains why the inhabitants of this variable climate, especially those of weakly constitutions, and mal-formed chests, are so peculiarly obnoxious to such complaints. This supposition also shows, in what manner preventing the effects of accidental cold, by flannel garments, or by removal to a warmer climate, is so eminently beneficial. The lungs are relieved from oppression, and left free to the exertion of the restorative powers of the constitution."
He next enters upon the inquiry as to what extent Scrofula ought to be regarded as a predisposing cause of Phthisis; but as this, in detail, would be disagreeably technical to the general reader, I shall merely say that, whilst, for good reasons, derived from very extensive dissection, he admits the greater liability of scrofulous persons to this fatal disease, yet that it often has a distinct and independent existence.
He does not presume, he modestly tells us, to meddle with the treatment of the disease; but the following practical observations are too judicious to be omitted:—
"In the cure of almost every disease, the removal of the producing cause seems to be the primary object. If, as I believe, a deficient performance of the functions of the skin be the principal cause of pulmonary consumption, the excitement of cutaneous perspiration requires particular attention. Maintaining an equable warmth, either from climate or from clothing, is one way of effecting this purpose; giving strength to the vascular system is another; and which, in my opinion, has not met with sufficient attention; at least, the principle on which its utility depends has not been sufficiently explained. All parts of the skin may be regarded as the extremities of the body; if the heart and arteries be wanting in power, the circulation and secretion of this remote part will be languid and deficient at all times, and will be liable to suspension from trivial causes. The maintenance of the strength of the vital powers appears to me essential to the cure of consumption. The skin cannot perform its office, unless these powers be supported; and, if this be deficient, pulmonary plethora will be inevitable. The relief which emetics afford in pulmonary complaints appears to arise from the production of cutaneous exhalation which they occasion.
"But if by promoting cutaneous secretion the cause of the disease is removed, still more remains to be effected; the lungs, perhaps, have already been thickened, or beset by tubercles; how, then, is the diminution of this disease to be attempted? In other parts, we frequently endeavour to accomplish a similar intention, by means reductive of the patient's strength—by aperients, by mercurials, and other medicines; but all means which debilitate should be cautiously employed."
There is so much truth, and such abundant good sense, in the above extracts, that I very much doubt, whether they do not comprise, as far as respects the unprofessional reader, all the information that can be given him; and, with regard to my professional brethren, they will be ready to admit, that the lessons of experience are never more required, that their judgment is never more severely taxed, than in their treatment of the varying phases, stages, and subjects of a disease which continues nearly as intractable as ever. Even that ingenious invention, the Stethoscope, can tell us little, if anything more, than the premonitory* symptoms, on which every experienced physician previously, and, for the most part correctly, grounded his opinion and practice; and, beyond this, I am not aware that modern discovery can fairly be said to have taken a single step in advance. Numberless are, indeed, the Essays which have made their appearance since Abernethy modestly placed his views before the public; but still the same sad tale remains to be repeated—that there is no cure for pulmonary consumption. You may guard against it, you may arrest its progress, you may relieve many of its symptoms, but there is no cure.
* The permanently quickened pulse and respiration are among the earliest premonitory symptoms. There was a third test, applicable tomany diseases besides Phthisis, to which Abernethy did not fail to call the attention of his pupils ;a testof more importance, perhaps, prior to the use of the Stethoscope, but still by no means to be set aside. It is this—in healthy respiration, the process is carried on by alternate expansion and compression of the chest both laterally and longitudinally. If the chest itself be the seat of disease, the lateral action will be favoured by the increased action of the diaphragm downwards; if, on the other hand, the mischief lie below the diaphragm, the lateral expansion will predominate. I do not think that this criterion, obvious and natural as it is, has been attended to sufficiently—and I can truly say that I have adopted it satisfactorily and very usefully in innumerable instances.