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says, that his infidel and anonymous friend, in the course of their discussions, handed him Collins's Discourse on the Grounds and Reasons of the Christian Religion,' and he implies that his antagonist also employed Hume's argument against miracles, to which Bishop Newton's work even if he, Dr. Keith, had known that work, could have afforded no antidote, as · Hume's argument was unknown at the time Newton wrote.'-p. 63. Now is it not marvellous that the first edition of Dr. Keith's work-originally written, as we are now told, to answer Collins's infidelity and Hume's sophistry, which Newton, not knowing, could not reply to-does not, as far as our best diligence can discover, so much as mention either Collins or Hume? Voltaire, Volney, Gibbon, &c., are quoted and answered; but Hume and Collins, against whom Dr. Keith now professes to have chiefly directed his argument, are not so much as named; nor, that we can discover, are their peculiar arguments even alluded to. Dr. Keith affirms, that · in his Introduction he alludes to Hume's argument;' we can see no such allusion, any more than to Collins. In the subsequent editions, indeed, there is, towards the very end of the book, a slight and insufficient mention of Hume; but none of Collins; and if the work originally contemplated a refutation of their arguments, it is in the first edition such mention would have naturally found its place. But, moreover, if the fact had been as Dr. Keith now states it, why was it not so stated when he was giving in his preface his motives for undertaking the work; and why, we ask, is it, that—at this stage only of the discussion—we and the publie hear, for the first time from Dr. Keith, of his design of replying to Collins ? And we must further ask, whether it was not we ourselves who, in our former article, first mentioned Collins at all ? and showed, that Newton, and Dr. Keith in that part of his work which is his own, had produced arguments and facts which, powerfully, unexpectedly—and on Dr. Keith's part unconsciously -refuted both Collins and Hume. If Dr. Keith's work was produced by having received from his friend a copy of Collins's book, is it not remarkable that it should be left to us,—first to mention that work, and to apply Dr. Keith's arguments against those whom he says he was answering, but to whom he never originally alluded? This seems to us quite unaccountable !
Dr. Keith and his advocate tell us that are some hundreds of references and quotations, particularly in the later editions, which are not to be found in Newton ;-admitted—we always stated and applauded the industry and ability with which Dr. Keith successively added to his original compilation from Newton the discoveries of modern travellers ;-and of course all this additional matter, which has doubled the size, and more than doubled the
interest and value of his book, has supplied a vast number of quotations which are not in Newton, and could not be, as they have all accrued since the Bishop's work was published; but we repeat our original suspicion, now strengthened into certainty, that in his earlier editions he borrowed from Newton—(not only without adequate acknowledgment, but with a studious attempt at concealment)—the main design and plan of his work, his most valuable facts and arguments, and his chief authorities and illustrations; and any doubt—which we might have been willing to entertain while awaiting Dr. Keith's explanation must be removed by the general insufficiency of the defence, and especially by the flagrant contradiction now brought to light between his assertion of having undertaken the work, because he found Bishop Newton's not suited to his particular purpose, and that other assertion, that it was not until after he had planned, and in a great degree executed, his work, that he so much as knew that such a book as Bishop Newton's existed. This is, to us, a most painful conclusion to have arrived at, and we would most gladly have avoided the necessity of stating it; but as Mr. Brewster and Dr. Keith have insisted, in the most peremptory, and even offensive manner, upon having our opinion—they have it; and if any reader who wishes to prolong the inquiry will only compare Dr. Keith's first edition, and its hundreds of coincidencies, with the corresponding passages of Newton, he will, we are satisfied, be convinced, as we are, that Dr. Keith's original work was either a plagiarism or a miracle.*
Art. X.-Lectures on Subjects connected with Clinical Medi
cine. By P. M. Latham, M.D., Fellow of the Royal College of Physicians, and Physician to St. Bartholomew's Hospital.
London. Vol. I. 8vo. 1836. DR. LATHAM has been long known as one of the most con
scientious and judicious cultivators of his profession. As a physician of, perhaps, the largest hospital in the metropolis, his opportunities of investigating disease have been equal to his industry in making use of them. Independently of diligence and
* Let it not be supposed, that if we have not followed Mr. Brewster into the innu. merable little details with which he has endeavoured to mystify the question, it has been for want of answers to these details. Our limits only admit, and the question only requires, that we should vindicate our own fairness, and deal with the single substantial question of the case. There are also many observations sug. gested by Mr. Brewster's and Dr. Keith's defence, which we have not stated, simply because, for the reasons already hinted, we had no inclination to extend the controversy beyond what had been inevitably forced on us.
occasion, those main springs of acquirement, circumstances have been favourable to him, as to all those who, situated similarly to himself, have lived to track the great improvements of physic made in this century, from their origin to their completion. These discoveries sprung up in their youth and have advanced with their maturer years, and in a rapidly progressive age it is a great advantage when the mind ripens with ripening events. Truths already common do not rouse the vigour of youthful powers : and elder minds are too rigid and inductile to be swayed or impressed by new thoughts. Dr. Latham's work bears all the marks of one who has begun with a new subject at an age when the entanglements of truth and error do not daunt nor disgust, who has followed it up with patient labour, and who has from much experience in teaching learned how to communicate clearly the knowledge which he has painfully collected. The volume in which he has embodied his thoughts is addressed to students in a peculiar, perhaps a quaint style, occasionally overdone with illustration, but oftener so picturesquely written as to carry us back to that vigorous English which pervaded the Elizabethan age, and the last example of which, in its application to medicine, is found in the works of the great Harvey.
Although a variety of topics are discussed by Dr. Latham, we shall confine ourselves to the single one of · Auscultation, or that method of investigating diseases of the chest which Laënnec discovered in 1816, and which has at length wiped off, with regard to an immense range of disease, the vulgar opprobrium of the uncertainty of medicine. They who have cast this reproach on the physician and his art, have not considered the nature of the evidence which guides him. The certainty of the conclusion in surgery as opposed to physic, has had its effect in depreciating the latter in the public mind, or at least, in the minds of those who have not the inclination or the power to look at the very different foundation of surgical and medical discipline. The surgeon investigates external maladies, and the evidence is as rapid as the eyesight and as undeceptive as the touch. The physician has to determine the existence of a malady hidden from his senses, and its investigation is and must be as painful and as fallible as thought. The surgeon need not in a majority of cases ask a single question. The physician has to learn the new, difficult, and obscure language of disease-often doubtfully, oftener mysteriously expressed, and which is not seldom at variance with the oral communications of his patient. The surgeon need not hesitate an instant, for he has direct evidence of the bleeding artery or the broken limb. The physician must and ought to admit a wholesome delay, in weighing the circumstantial evidence which
enables him to determine at length, with the certainty of sense, not only what invisible organ labours, but what part of it.
As soon as anatomical knowledge could be obtained, surgery advanced rapidly, and the history of this branch of science shows that it does not, like physic, require an indefinite time to extend its empire. A few gifted men have in their day carried on the land-marks of their province immeasurably beyond its former limits. Whereas in physic, the prime antithesis of the length of art and the shortness of life has always been felt, so that its perfections are due rather to the aggregate efforts of generations than to those of individuals.
One reason,' says our author, 'why surgery is more popular than medicine is, that it is easier. Do not, I beseech you, imagine that I wish to disparage surgery. In a profession like ours, nothing can show such bad feeling, or such bad taste, as purposely to let fall expressions which cast an imputation of inferiority upon those who happen to cultivate a different portion of the same field of science and usefulness from our own. And even here I will allow, if you please, that cases occur in the department of surgery, beset with difficulties and perplexities, which we in the department of medicine do not meet with, and which require information, and judgment, and skill of the highest order, to surmount. But I am now speaking of the ordinary routine of cases, such as we find them in hospitals ; and upon a comparison of such cases, surgery is certainly much easier than medicine ; and students take to it the more kindly because it is easier.
'Surgery, for the most part, requires fewer circumstances to bring you to a knowledge of its object than medicine does. In surgery there are prominent points of interest, which arrest and command the attention at once; in medicine the points of interest are to be sought after, and, being found, are to be retained and cherished by much labour of the understanding. External sores, external inflammation, and broken bones, require only to be seen and handled in order to be known. But the same knowledge which, in surgery, is obtained by the use of the senses, in medicine, which is conversant with internal disease, can only be acquired by a process of reasoning; and reasoning is more difficult than seeing and touching, and its conclusions are more uncertain, and much more liable to error.
Moreover, the adaptation of curative means requires more vigilance in medicine than in surgery. There is no end of the circumstances to be taken into consideration day after day, in order to practise medicine with tolerable success. A man has an external inflammation : the surgeon sees it, and is at once sure of its existence ; he prescribes for it, and sees its gradual decline as plainly as he first saw its rise and progress. A man has an internal inflammation ; but the physician, not seeing it, is obliged to come to the knowledge of its existence by a great variety of considerations : he prescribes for it, and is again obliged to enter into a variety of considerations before he can know that it has begun to decline or has ceased. The uncertainty of physic I readily admit; but I do not admit the vulgar reproach which has followed from it. There is nothing absolutely sure but what rests upon the basis of numbers, or falls within the sphere of the senses. Where reasoning begins, there begins uncertainty, and on this account the highest and the best things in the world are all uncertain, and so is our profession. But from this very uncertainty those who practise it successfully claim their greatest honour: for where there is no possibility of error, no praise is due to the judgment of what is right.'-pp. 39-42.
To come at once to the subject of Auscultation,—by this one happy and happily improved discovery the physicians of the present age have forced one half of human diseases to give us a more direct and open statement of their nature. We find that they have a language of their own which, though varying with the varying malady, is still clear and distinct, and intelligible, to all who have ears to hear, and a patient mind to understand. All the diseases of the chest, whether of the heart, or the great vessels, or of the lungs, are now ascertainable—and where, from their nature and our present limited knowledge, they are not curable, still may they be alleviated. Not only the entire organ, but each separate portion of it can be scrutinized. Not only can the modern practitioner state where the respiration labours and what part is clogged, but why, and how it is impeded. In a word, he now knows not merely the symptom but the disease.
Auscultation,' says Dr. Latham, professes to make us acquainted with the actual condition of the lungs in many of the most important diseases incident to them; their actual condition at any particular time; and their changes from one condition to another from time to time,
I am not aware that, before auscultation lent its aid to diagnosis, we could do more than speak generally concerning the diseases of the lungs during the life of the patient. We could affirm generally that the lungs were inflamed ; and, knowing, from our acquaintance with morbid processes, that it was the tendency of inflammation to produce such and such changes of their structure, we were aware what perils it involved, and could anticipate with tolerable accuracy what we should meet with when the patient died. So, too, we could affirm generally that there were tubercles or vomicæ in the lungs; and, understanding the forms and processes of phthisical disease, we could foretel in the main what we should find after death.
"But auscultation anticipates the disclosures of morbid anatomy. Nearly all that dissection can unfold, it tells while the patient is yet alive. It does more: it brings us acquainted with diseases long before they have reached their fatal stage. By dissection we come in with our knowledge at last, and gain assurance of the disease from its ultimate results. By auscultation we are often--very often-enabled to make our knowledge keep pace with the disease from its least and earliest beginnings, through all the stages of its progress to the end.'-pp. 168, 169. The comfort of such knowledge can only be conceived by him