« 이전계속 »
of them had begun to swell about the head, he removed it for further observation; and in twenty-four hours it was found dead.
Having ascertained the mode of death from the action of the ordeal-bean, I did not consider it advisable to study farther the details of its action by means of experiments on animals, because I had been fully informed as to this in a more precise manner by an experiment made with the bean in my own person, I shall conclude this notice with an account of what I experienced ; and I trust the details will not appear needlessly minute, as they seem to me to establish an action of a very singular kind in the case of this poison, and one of which we might discover other instances among known poisons, had we equally precise opportunities of determining the true phenomena.
Having some doubts whether I had obtained the true ordealpoison, as it tasted so like an eatable leguminous seed, I ate one evening the eighth part of a seed, or six grains, about an hour after a very scanty supper. During an hour that I passed in bed reading, I could observe no effect whatever, and next morning I could still observe none. I am now satisfied, however, that a certain pleasant feeling of slight numbness in the limbs, like that which precedes the sleep caused by opium or morphia, and which I remarked when awake for a minute twice or thrice during the night, must have been owing to the poison.
On getting up in the morning I carefully chewed and swallowed twice as much, viz., the fourth of a seed, which originally weighed forty-eight grains. A slight giddiness, which occurred in fifteen minutes, was ascribed to the force of the imagination; and I proceeded to take a warm shower bath; which process, with the subsequent scrubbing, might take up five or six minutes more. The giddiness was then very decided, and was attended with the peculiar indescribable torpidity over the whole frame which attends the action of opium and Indian hemp in medicinal doses. Being now quite satisfied that I had got hold of a very energetic poison, I took immediate means for getting quit of it, by swallowing the shaving water I had just been using, by which the stomach was effectually emptied. Nevertheless I presently became so giddy, weak, and faint, that I was glad to lie down supine in bed. The faintness continuing great, but without any uneasy feeling, I rung for my son, told him distinctly my state, the cause, and my remedy
-that I had no feeling of alarm, but that for his satisfaction he had better send for a medical friend. Dr Simpson, who was the nearest, reached me in a few minutes, within forty minutes after I ate the seed, and found me very prostrate and pale, the heart and pulse extremely feeble and tumultuously irregular; my condition altogether very like that induced by profuse flooding after delivery ; but my mental faculties quite entire, and my only sensation that of extreme faintness, not, however, unpleasant. Dr Simpson judged NEW SERIES.-NO. III. MARCH 1855.
it right to proceed at once for Dr Douglas Maclagan as a toxicological authority, and returned with him in a very few minutes.
In his absence, feeling sick, I tried to raise myself on my elbow to vomit, but failed. I made a second more vigorous effort, but scarcely moved. At once it struck me—“This is not debility, but volition is inoperative." In a third effort I was more nearly successful; and in the fourth, a resolute exercise of the will, I did succeed. But I could not vomit. The abdominal muscles acted too feebly; nor were they much aided by a voluntary effort to make them act. I then gave up the attempt, and fell back, comforting myself with the reflection that vomiting was unnecessary, as the stomach had been thoroughly cleared. At the same time the sickness ceased, and it never returned. There were now slight twitches across the pectoral muscles. I also felt a sluggishness of articulation, and, to avoid any show of this, made a strong effort of the will to speak slowly and firmly, through fear of alarming my son, who was alone with me. .
Dr Maclagan, on his arrival, thought my state very like the effects of an over dose of aconite. Like Dr Simpson, he found the pulse and action of the heart very feeble, frequent, and most irregular, the countenance very pale, the prostration great, the mental faculties unimpaired, unless perhaps it might be that I felt no alarm where my friends saw some reason for it. "I had, in fact, no uneasy feeling of any kind, no pain, no numbness, no prickling, not even any sense of suffering from the great faintness of the heart's action ; and as for alarm, though conscious I had got more than I had counted on, I could also calculate, that, if six grains had no effect, twelve could not be deadly, when the stomach had been so well cleared out.
Presently my limbs became chill, with a vague feeling of discomfort. But warmth to the feet relieved this, and a sinapism over the whole abdomen was peculiarly grateful when it began to act. Soon afterwards the pulse improved in volume, but not in regularity. I was now able to turn in bed; and happening to get upon the left side, my attention was, for the first time, directed to the extremely tumultuous action of the heart, which compelled me to turn again on the back, to escape the strange sensation Two hours after the poison was swallowed, I became drowsy, and slept for two hours more; but the mind was so active all the while, that I was not conscious of having been asleep. On awaking, the tumultuous action of the heart continued. In an hour more, however, I took a cup of strong coffee ; after which I speedily felt an undefinable change within me, and on examining the condition of the heart, I found it had become perfectly and permanently regular.
For the rest of the forenoon I felt too weak to care to leave my bed ; and on getting up, after a tolerable dinner, I was so giddy as to be glad to betake myself to the sofa for the evening. Next morning, after a sound sleep, I was quite well.
On considering this narrative, as well as the experiments on the rabbit, it will appear evident that one principal action of this extraordinary poison, and the immediate cause of death in fatal cases, is depression, ending in paralysis, of the heart. I think it may be also safely inferred, that another action is paralysis of the voluntary muscles, attended with suspension of the influence of volition. It does not appear to me that mere faintness is adequate to account for the extreme muscular inability I experienced ; neither do I conceive it possible for me to have been deceived by the strong conviction I felt of the will being inoperative in its inAuence over muscular motion. My failure reminded me forcibly at the moment of a phenomenon invariably remarked during the impaired acuteness of the mind which often attends the early stage of hemiplegia. When the patient is told to stretch out the palsied arm, he stretches out the other, however pointedly the physician turns his attention on the powerless limb, and even though the patient himself keeps his eye on it; thus clearly showing that the will orders, though the muscles cannot obey.
The integrity of the mental faculties, during the prostration of that cerebral function which conduces to the operation of the will or muscular action, was most remarkable. The minute details I have given are chiefly intended to illustrate this point; and I am persuaded that I have not overstrained any one article of evidence on that head.
The apparent efficiency of coffee, in removing what remained of the poisonous action after five hours' duration, is not unworthy of notice. Every physician knows that coffee is used for dispelling the after effects of various narcotic poisons; but its real utility has been doubted. In the instance of the present poison, the post hoc at least was both very prompt and most complete, so far as the main symptom, the irregular heart, was concerned ; and I have myself no doubt of the reality of the curative action.
Whether the extraordinary power, which this poison possesses in depressing the action of the heart, may be susceptible of application in the exercise of the healing art, is a question which time and experiment will alone enable us to answer. Its mere potency is no objection, when it is considered that drugs so potent in poisonous energy as hydrocyanic acid, aconite, and digitaline, are now firmly established in medical practice as safe and efficacious remedies.
Let me advert lastly to a peculiarity in the action of the ordealbean which struck me forcibly while labouring under it. Philosophers have thought it not unworthy of inquiry, how in criminal executions death may be completed without physical suffering to the criminal. Governments have even consulted science on the subject. But science has not yet satisfactorily solved the question. Meanwhile, I suspect it has been accidentally solved by the negroes of Old Calabar. At least, so far as the effects of their state-poison on myself went, there was no bodily uneasiness except the single attack
DR MARKHAM ON THE TREATMENT OF DISEASE.
AM ON THE TREATMENT OF DISEASE. [MAR.
of sickness-apparently the relics of the action of my peculiar emetic,—but simply a sense of sinking vitality, with clearness of mind, and without any sensation deserving in the slightest degree to be called physical distress. We know, indeed, that many forms of extreme fainting, of which this is evidently one, are attended with feelings, which, if not positively pleasurable, are certainly quite unallied to pain. Death by simple fainting, without any preparatory painful process, is evidently what a humane execution should aim at producing. And all this, I apprehend, will be effected by the Calabar Ordeal-bean.
ARTICLE II.- Remarks on the Treatment of Disease. By W. 0.
MARKHAM, M.D., Assistant Physician to St Mary's Hospital, London.—(Continued from p. 33.)
" The nature of medical causation is such, that it takes as much time and trouble to rectify an error as to establish a truth. Thus it may require the experience of one man's life to arrive at some plausible theory, and the counter-experience of another man's life to show that it is false.”—Latham's Clinical Medicine.
The influence exercised over the human intellect by Bacon's master spirit is, amongst other illustrations, supposed to have been manifested, and in a striking manner, by advancements made in the art of medicine,-in a more rational application of it to the cure of disease; and at this present day, I imagine, that no body of scientific men makes greater claim for the credit of pursuing the inductive method, in their investigations, than do the practitioners of the medical art; and perhaps no body of scientific men possesses more just claims for such credit. The reason of this is plain enough.
The direction in which the mind of the physician is turned by the physical and mathematical branches of study, whose cultivation is absolutely necessary, as stepping-stones to a knowledge of his profession, naturally gives to his ideas a positive and somewhat a material character; he demands to feel, to see, and to touch; and by the exercise of these faculties of the senses it is that he becomes, for the most part at least, possessed of a knowledge of his business.
He is thus, by the very nature of his previous education, by his study of chemistry, of natural philosophy, and of other kindred branches of the positive sciences, taught early to draw correct inferences respecting causes and their effects, and to trace out the proper connections in which sequences stand to antecedents; he is thereby continually warned against a fallacious acceptance of conclusions ; he therein finds a safeguard against the great and very numerous temptations to the ready reception of fallacies besetting him in bis investigation of those matters, which are the special objects of his professional pursuits. And such a safeguard he indeed requires, for these pursuits are constantly leading him into unknown regions of knowledge; his inquiries have perhaps scarcely commenced ere he reaches a barrier which bars all further progress; the question he is investigating remains unsolved; the problem unsatisfied; his scientific aids and reasoning powers can help him no further; sane reason tells him he can proceed no further; here is the limit to his knowledge, fixed until such time as new lights shall shine upon and dispel the darkness which now obstructs his vision. And it is just in these very regions of unknown facts; of the nature of the connection of the physical and the vital forces, for example; of the intimate action of various matters upon the different organs and parts of the body; of the essences of disease; in a word, it is in that immense region of the unknown, which on every side at once impedes the physician's steps, and stimulates his energies for research, that the syren Imagination is ever on the alert, to delude him into brilliant paths of beautiful errors. When once the feet are engaged in those enticing paths, how difficult is a retrograde movement back into the quiet, unobtrusive walks of quiet reason! Even John Hunter had his day-dreams in the regions of fancy.
Well, the end and aim of the physician's strivings is to treat disease, to anticipate its attacks, or divert their force; towards this object all his various learning is concentrated—to this all his studies are subservient; and now, let me ask, does he in this, the prime act of his, still take for his constant guide that inductive method, that cautious analysis of events, which adjusts their relations as antecedents and as sequences, as causes and as effects, and which we have supposed hitherto to have been his guide, while he was acquiring a
knowledge of all those lesser lights that were to lead him to this 1. great purpose—the cure of disease ?
I endeavoured on a former occasion to answer this question in general terms, and was compelled, in a certain sense, to answer it in the negative. I then ventured to suggest, that an unbiassed investigation of the subject forces upon us the conclusion, that our present methods of treating acute diseases were in the highest degree unsatisfactory ; that the data upon which such methods of treatment were founded are uncertain ; and that the results of such treatment were found to be most contradictory in the hands of different individuals.
This view I illustrated by referring to the very opposite practices followed by equally talented and honourable practitioners in their treatment of disease; to the revolutions which the opinions of observers, in different generations, as to the powers and effects of remedies, and of the same observers at different periods of their own experience, were continually undergoing.
And then I ventured to ask, specifying some particular acute inflammation, the actual grounds upon which the physician, who proceeds to treat such inflammation according to orthodox methods, builds his belief in the efficacy of his remedies; that he should state in distinct terms the reasons upon which rests his faith in the effi