Pathological researches on phthisis

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CHAPTER I Respiratory Organs, 3

Art. I. Of the Lungs, . .... lb.

Obs. I. Tubercular Cavity, including three-fourths of the Right

Lung, 16

Obs. II. Mass of organized Fibrin filling a moderately sized

Tubercular Excavation, 22

Viii CONTENTS.

Obs. III. Healthy Fragment of Pulmonary Parenchyma, unattached, in the midst of an Excavation, . • 27

Of!

State of the Bronchia,

Acute Inflammation of the Substance of the Lungs in the

last stage of Phthisis, 3'

Acute Inflammation towards the close of other Chronic Dis-

38 39 eases,

Art. II. Of the Pleura;,

Adhesions of the Pleura? in Phthisis, .... 'b-

" in cases fatal from other Diseases, . • 41 Acute Pleurisy towards the close of Phthisis and other

Chronic Affections 42

Art. III. Of the Epiglottis, Larynx and Trachea, . . ib.

Sec. 1. Ulcerations of the Trachea, .... 43

2. " " Larynx 46

3. " " Epiglottis, .... ib.

State of these Organs in Subjects dead from other Chronic

Diseases, 48

CHAPTER II. Organs of Circulation, 49

Art. I. Of the Heart and Pericardium, .... ib.

State of the Heart in other Chronic Diseases, . . 52

Art. II. Of the Aorta, ib.

State of the Aorta in other Chronic iseases, . 54

CHAPTER III. Digestive Organs, 57

Art. I. Of the Pharynx and Oesophagus, ... ib.

State of these Organs in other Chronic Diseases, 58

PATHOLOGICAL ANATOMY. 1\

Art. II. Stomach, 59

Sec. 1. Of tlio Volume and Situation of the Stomach, . ib.

" " " - " in other

Chronic Diseases, ib.

Sec. 2. Softening with diminished Thickness of the Mucous

Membrane of the Stomach, .... GO

Sec. 3. Redness combined with thickening, with a Mamillated State or Softening of the Mucous Membrane, and occurring in the anterior portion of the Stomach, 64

Sec. 4. Redness with Softening of the Mucous Membrane

lining tlie great Cul-de-sac of the Stomach, . G5

Sec. 5. The inamillutcd appearance and greyish color of the

Mucous Membrane of the Stomach, . . . C7 Sec.G. Ulcerations of the Mucous Membrane of the Stomach, 68 Sec. 7. Some other morbid changes of the Mucous Membrane

of the Stomach, GO

Tabular View of the different Lesions of the Ciastric Mucous

Membrane, 70

Tabular View of the different Lesions of the Gastric Mucous

Membrane in other Diseases, .... 71

Art. III. Of the Duodenum, 72

IV. Of the Small Intestine, 73

Sec. 1. Of the Mucous Membrane of the Small Intestine in its

healthy state, 74

Sc 2. Pat hology of the Small Intestine, .... 78 Obs. IV. Large Intestinal Ulcerations, Perforation of the Small

Intestine, 84

State'of the Small Intestine in other Chronic Diseases, 90

Art. V. Large Intestine, 91

State of the Large Intestine after other Chronic Diseases, 99

X CONTENTS.

CHAPTER IV. Lymphatic Glands, 99

Art. I. Of the Mesenteric Glands, 100

II. Of the Mesoca?ca], Mesocolic, and Lumbar Glands, 104

III. Of the Cervical, Axillary and Bronchial Glands, . 105 State of the Lymphatic Glands after other Chronic Diseases, 100

CHAPTER V. Biliary Apparatus, ....... 107

Art. I. Of the Liver, ib.

State of the Liver after other Chronic Diseases, . . 108 Art. II. Of the Bile and Gail-Bladder, .... 112 State of the Bile and Gall-Bladder after other Chronic Diseases, 114

CHAPTER VII. Urinary Organs, jiy

Obs. V. Tubercular Matter in the Right Kidney and corresponding Ureter, 118

In other Diseases, 121

CHAPTER VIII. Genital Organs, . ... 109

Art. I. Of the Male Genital Organs, ib

PATH0L0C1CAL ANATOMY. XI

Obs. VI. Tubercular Matter in the Prostate, Vesiculse, asid Vas

Deferens, 122

State of the Male Genital Organs after other Acute or

Chronic Diseases, J28

Art. II. Of the Female Genital Organs, ... 129

State of the Female Genital Organs after other Chronic

Diseases, 130

CHAPTER IX. Pkiuto.neom, . 130

Obs. VII. A thick layer of the Tubercular and Grey, Semitransparent Mutter in the Epiploon and Mesocolon, ib. State of the Peritoneum after other Chronic Diseases, !■'!-

CHAPTER X. Brain and its Mkmuranes, . .... 139

State after other Chronic Diseases, . . . 142

Obs. VIII. Hydatids in the upper part of the Brain, . 145

IX. Tubercles in the Cerebrum and Cerebellum, . 151

Summary, 157 xJj CONTENTS.

CHAPTER I. Symptoms of Phthisis, 165

Table of the duration of Phthisis, .... J69

Cough, 171

Expectoration, ib.

Haemoptysis, 176

Obs. X. Copious Hemoptysis unsuccessfully treated by Bleed-

Dyspnoea, 185

Pain, 186

Fever 189

Sudamina, 193

Thirst, . 194

Appetite, jj,.

Diarrhoea, jgj

Emaciation, jgp

SYMPTOMS. XIII

CHAPTER II. Diagnosis, 201

Diagnosis of the first period of Phthisis, . . . 202

Obs. X. (bis). Phthisis recognised the seventeenth day from its

invasion, 205

Diagnosis of the second period of Phthisis, . . . 210 Obs. XI. Bronchial Dilatation in the summit of the Lungs mistaken for a Tuberculous Excavation, . . 212

CHAPTER III. Pneumonia and Pleurisy occuriuno shortly bbpore death

CII AFTER IV.

Symptoms of Ulcerations of the Epiglottis, Larynx

and Tracbi l, 219

Art. I. Symptoms of Ulcerations of the Epiglottis, . ib.

Obs. XII. Ulcerations of the Epiglottis unaccompanied by those

of the Larynx and Trachea, .... 220

X III. Complete destruction of the Epiglottis, . . 225

XIV. Deep Ulcerations of the Epiglottis and Larynx, 230

Art. II. Symptoms of Ulcerated Larynx, . . . 237

III. Symptoms of Ulcerated Trachea, . . . 239

Obs. XV. Large Ulcerations of the Trachea. Symptoms very

indistinct, 240

XVI. Extensive and deep Ulcerations of the Trachea. Destruction of portions of the Cartilaginous Rings. No Symptoms, 246 t

CONTENTS.

Inflammation of the Lining Membrane of the Trachea without Ulceration, 252

CHAPTER V. Symptoms of the various alterations of the Gastric

Mucous Membrane, ..... 253

Art. I. Symptoms of Softening with diminished Thickness of

the Mucous Membrane of the Stomach, . 254

Obs. XVII. Predominance of Gastric Symptoms, . . 256

Art. II. Symptoms of Inflammation of the Mucous Membrane of the Stomach when limited to its anterior surface, ........ 263

Obs. XVIII. Strongly marked Gastric Symptoms, . . 264

Art. 111. Symptoms observed when the Mucous Membrane of the Stomach is red and softened in the great Cul-de-sac, ... .... 270

Obs. XIX. Few and slightly marked Gastric Symptoms, . 271 Art. IV. Symptoms of Simple Ulcerations of the Gastric Mucous

Obs. XX. Rather prominent Gastric Symptoms, , . ib.

State of the Digestive Functions when the Gastric Mucous Membrane was Mamillated and Greyish, also when

it was perfectly sound, 280

Summary of the four preceding Sections, .... 281 Obs. XXI. Incomplete Cicatrix of the Gastric Mucous Membrane, 283

XXII. Transformation of a portion of the Muscular Coat

into a Semi-cartilaginous Substance, . . 286

Art. V. State of the Tongue, 293

Obs. XXIII. Tongue of a deep red, at first moist, afterwards

dry. Gastric Mucous Membrane healthy, . 294

SYMPTOMS. XV

CHAPTER VI. FCNCTIONS OF THE Ge.NITAL ORGANS, ... 302

Art. I. Generative Functions in .Men, , ib.

CHAPTER VII Cerebral Svmptoms, 306

Ons. XXIV. Ventricular Arachnitis. Symptoms prominent, ib.

XXV. Circumscribed Sub-arachnoidean Inflammation;

partial softening of the Brain, . . . 311

WVi. Partial softening of the Brain, .... 313

CHAPTER VIII. Varieties which Phthisis presents in its Progress, 318

Ohs. XXVII. Phthisis latent during Twelve Months, . 319

XXVIII. " " " Eight " .322

XXIX. " " " Thirty " 327

XXX. " " very chronic, overlooked, . 333

XXXI. " " Encysted Tubercles, . . 340

XXXII. " " Tuberculous Patches between Per-

itoneal False Membranes, . . 345

Summary of the six preceding Observations, . . 349

Acute Phthisis, . 352

Obs. XXXIII. Phthisis fatal on the Thirty-fifth day, . . ib.

XXXIV. Acute Phthisis. Consecutive Pneumonia the

cause of Death, ... . 357

XVI CONTENTS.

XXXV. Phthisis fatal in Fifty Days, ... 362

XXXVI. " " in Forty-eight Days, . . 368

Summary of the preceding Observations, . . . 3/2

Obs. XXXVII. Phthisis fatal in Thirty Days, ... 374

CHAPTER IX. Symptoms of Perforation of the Lung by Tuberculous

Obs. XXXVIII. Excavation communicating with the Pleura; and Bronchia. Death, Thirty Days after the Perforation, ...... ib.

XXXIX. Excavation communicating with the Pleura?, but not with the Bronchia. Death, Three Days after the Perforation, . . . 383 XL. Excavation communicating with the Pleura? and

Bronchia, 387

XLI. Excavation communicating with the Pleura? and Bronchia. Death, Eighteen days after the Perforation, .... 390 XLII. Excavation only communicating with the Pleura?. Death, Thirty-six Hours after the Perforation, 394

XLIII. Excavation communicating with the Pleura? and Bronchia. Death, Twelve Hours after the

Perforation, 39g

Analysis of the preceding Observations, . . . 401

Obs XLIV. Excavation communicating with the Pleura? and

Bronchia. Death, Six Days after the Perforation, 403 Continuation of the Analysis 407

SYMPTOMS. XVII

CHAPTER X. Sddden Deaths, -!14

Art. I. Unexpected Deaths, which may be explained more or

less plausibly by the slate of the Organs after Death, ib.

Obs. XLV., ib.

Akt. I. Sudden Deaths, which are not accounted fur by the

post-mortem appearances, .... 422

Obs. XLVII., ib.

XLVIII., 425

XLIX. 429

CHAPTER XI. Causes of Phthisis, ...... 437

Influence of Sex, 438

" of Pneumonia and Tleurisy, ... . ib.

" of EroncLitis, 4-11

Hereditary Influence, 44C

Influence of Age, ■ 447

CHAPTER XII. Treatment, . 448

Will CONTENTS.

Appendix

A. Origin and Development of Phthisis, ... ib.

13. Diagnosis of Phthisis, 460

(.'. Influence of Sex in the Production of Phthisis, 464

I). " of Pneumonia, .... 466

E. " of Bronchitis, 467

F. " of Dress, 4C8

G. " of Age, 469

of Dust, 473

of Moisture, 477

" of a Dry and Hot Atmosphere, . . 479

" of Animal Emanations, ... ib.

" of Vegetable, " .... 480

" of Mineral, " ib.

" of Impure Air, ib.

" of Active Life in Open Air, . . 481 " of Sedentary Life with confined posture of

the Body, ib.

Exercise of the Vocal Organs 482

Influences which predispose to Phthisis, . . 483

Preservative Influences, 484

SYMPTOMS. XIX

Influence of Climate, 484

Contagion of Phthisis, -4-ii

Influence of Season, ..... I'- ll. Essay on Treatment, 489

American Editor's Arr-tSDix, ... . 523

AMERICAN EDITOR'S PREFACE.

This edition of Louis's work on Phthisis is called the re-publication of Dr. Cowan's translation, and such it substantially is. Yet 1 should feel that I was wanting in my duty as Editor, 'did 1 not make the following statements. There are many omissions in the English translation, some of which are not very important, while others materially alter the signification of the original work. All of 'hese have been supplied. Dr. Cowan has also fallen into some errors. These statements are nn r as-i rlions I allow, but were it necessary, I could give a list of errata ; it is of little moment, however, for me to state any thing farther than this, that the re-publication differs very materially from the English translation.

It will be seen that I have placed all Dr. Cowan's additions ;n the form of an appendix, instead of having them scattered in virions pans of the work. Some sections of this appendix are very valuable, as for example, C, D, E and G. These contain the analyses of facts collected by such men as Parent Duchatelet, Eenoiston-Chateauneauf, hard laborers in the cause of science, and who never lay down a principle without having it rest upon a firm foundation of facts. These sections contain likewise summaries of valuable memoirs by Dr. Lombard of Geneva, Sec. These summaries are in general xxii American editor's preface.

made correctly, but in one case there are so many discrepancies between the statements of Dr. Cowan and the original paper of Dr. Lombard (vide page 472), that I have found it impossible to correct Dr. Cowan's remarks without altering the whole paragraph or omitting it altogether. The Essay on Treatment, H, 1 candidly confess I should have preferred not to have seen appended to a work written by Louis. Let me be understood. I do not doubt that many valuable remarks are contained therein, for where is there any effort of the human mind which does not contain some truth ? But in quoting, as Dr. Cowan has, from works which are written as differently as possible from the strict method pursued by Louis, he has implied that he himself is not so devoted a disciple of the Numerical School, as we were led to expect from his having undertaken to translate a work of this kind.

It may be said that I wish to excite a partisan spirit by this remark. Far be it from me to wish for sects and intolerance either in medicine or religion. 1 wish to see one boldly express his opinion and act up to it. It is the peculiar charm of the Numerical School that it invites all to become laborers to advance the holy cause of truth ; it tells all that if they will strictly follow its rules success will be the result. It teaches every man that he ought not to consider any principle ascertain which has not been proved. Dr. Cowan quotes from many who do not hold this maxim to be true.

I have given in this re-publication all that is contained in the original English translation, but 1 would particularly invite the reader to judge of Louis's method as it stands developed in the text, and after his decision let him peruse all the addenda in which, as I have already stated, are some valuable principles, and very many important facts.

AMERICAN EDITOR S PREFACE. XXI11

The original work on Phthisis was written and published before that on Typhus was commenced. This is the reason why the former has not such a finished aspect as the latter. It is not, in fact, so philosophically written ; the Numerical Method is less perfectly displayed in it than in the two volumes on Typl'us ; but it bears upon its face, as the whole of Louis's writings do, mathematical exactness. Need I say more than this to induce any lover of truth to peruse this volume attentively ?

It will depend upon the reception these works meet with from the public, whether the translation of the remainder of Louis's writings be undertaken, but I hope ere long that the whole of them, which have not yet been published in this country, will appear in the present shape.

TRANSLATOR'S INTRODUCTION.*

" Tho foundation of all knowledge must be a careful and extensive acquisition of/acts ; and the first duty of an inquirer, in any department of science, is to bind himself down to such a patient accumulation, bewaring of all premature attempts to combine and generalize them." — Vide Abercrombie on the Intellect. Powers, page 375.

"Ce que se rattache a l'espece humainc, considerce en masse, est dc l'ordrc des faits physiques; plus le nombre des individus qu'on observe est grand, plus la volontii individuelle s'efface et laisse predominer la srrie des faits geni-raux." — Quetelet de V Influence des Saisons sur V Homme. Bruxelles, 1832.

Whether we give publicity to our own researches, or become the means of disseminating the opinions and investigations of others, we should be alike actuated by a conviction

* Since much of the information scattered through the course of this introduction, respecting the author and the method he has pursued, to be correct, must have required peculiar opportunities, the translator feels called upon to say, that he has spent nearly four years in the hospitals of Paris ; that he assiduously followed the visits, post-iuortems and lectures of M. Louis, at La Pitie, for twelve months ; that he has been honored with the private intimacy of the author, audby his kindness inspected the tables from which the present volume was composed, as also those for his researches on the " Affection Typhoide." These various sources have all conspired to impress him with a deep conviction of the value of M. Louis's works and method, and his presenting the English reader with the present volume is a simple consequence of his sincerity. 4

XXVI TRANSLATOR S INTRODUCTION.

of their utility in the abstract, the want of further information, and a conscientious impression that the facts they embody are the literal transcript of realities, and not the distorted or partial materials so easily accumulated for the support of a theory or the making prevalent individual opinion. At a moment like the present, when books are daily teeming from the press in almost every department of medical science, any useless addition to their number ought scrupulously to be avoided ; for both time and intellect are wasted in the discrimination of what is worthless or mere repetition, instead of being occupied in the acquirement of what really forms an increase to the knowledge we already possess. In the more positive sciences, the evil alluded to is less sensibly felt, the greater precision of the principles on which they are founded, limiting the field for speculation, by giving a necessary convergence to faithfully detailed phenomena, and at the same time acting as guides for the rejection of inaccurate imperfect description, or hasty ill-digested induction.

Medicine, for many very evident reasons, has been and continues to be the victim of varied and contradictory hypotheses : — the minds of all who have attempted to trace its deviating course, have wearied in the vague conflict of opinions, and have either sheltered themselves under the authority of a name, or satisfied their doubts by the creation of a principle quite as hypothetical and uncertain as any by which they were previously bewildered. This favored progeny of their fancy, like colored media to the vision, soon tinges all intellectual combinations, and falsifies the very evidence of the senses ; facts seem to multiply in its support, and what at first was regarded as probable, soon strengthens with the fond hope of discovery and the assent of eager, uninquiring enthusiasts, becoming the basis of a system from which dissent

TRANSLATOR S INTRODUCTION. XXVII

involves error, and opposing facts are either overlooked or discredited. With such a mental Lias, the very talents and researches of an individual become injurious to a profession he would otherwise have adorned, and how often in looking back over the history of medicine, can we see, as it were, our progress arrested by some favorite dogma of a powerful but prejudiced mind, until a rival intellect lays bare the fallacy, erects another in its stead, changing little more than the name of what it thought to have annihilated. The " Solidists," the " Fluidisls," the " Brownists," the " Cullenists," and the " Broussaists," with many others, have undoubtedly obstructed the path of rigorous and impartial observation, by limiting the wide field of philosophic inquiry to the too often forced adaptation of facts calculated to support their own peculiar and almost necessarily imperfect conceptions : and although their labors have not been fruitless, and much positive knowledge may be gleaned from the mass of their investigations, who does not feel that its volume has been infinitely lessened, and its value impaired, by the pre-existence of a principle it was intended to establish, rather than eliminate ? The ease with which a theory may be proposed and supported, is exactly proportionate to the vagueness of our know ledge, to the absence of impartial incontestable facts ; and until the latter have enjoyed that natural precedence which has been granted them in every science that deserves the name, our deductions can never be established upon any satisfactory and lasting foundation. Could genius grasp the bearings of those laws which influence the health and modify the diseases of organized beings, still, observation would be necessary to test the truth or falsehood of its inspirations, but from the finite nature and contracted limits of the human faculties, the necessity of observation if not more absolute is at least more glaring, xxviii translator's introduction.

and the conviction of our mental feebleness should make us shrink from all hasty precocious generalization.

Let the candid inquirer contemplate the mass of crude amorphous materials which ages have accumulated ; let him glance over those creeds of medical infallibility which have successively risen and waned in the opinion of mankind ; then let him direct his view to the living representatives of systems either stamped with antiquity, or attractive by their modem freshness and apparent novelty, and what are the conclusions he must form ? Let him change his locality and he changes his principles, while every where facts are their reputed foundations. The pure antiphlogistics of the French, the contro stimulants of the Italians, the omceopathic of the Germans, and the hepatic nostrums of England, all lay claims to his attention, and are all recommended as the fruits of long experience and multiplied observation. The discovery of truth from such conflicting testimonies, if possible, is at least a Herculean task, and he either becomes the bigoted partisan of a sect, or what is far more rarely the case, resolved to have recourse to rigorous impartial inquiry. The results of his labors may indeed be unsatisfactory, and must necessarily embrace but a limited portion of the vast field of medical investigation, he will, however, ensure the satisfaction of collecting materials available to others, and have sacrificed the desire of ephemeral reputation, to the far higher motive of being really useful. It is indeed a subject of deep congratulation, that minds such as these are daily multiplying, and in looking back on what a few years have effected, there is every encouragement for future anticipation, and every reason to suppose, that the results to which we shall ultimately arrive, though probably never of any Utopian character, will at least commend themselves to the reception of every sound and unprejudiced mind.

What names, we would ask, continue to survive the oblivious tendency of time ? The detailers and chroniclers of facts not opinions ; the latter have long " sunk into the abyss of forgetfulness, and truth alone swims over the vast extent of ages."

Our author presents an interesting example of the effect produced upon the mind, by the contemplation of the uncertain nature of much of our medical knowledge ; and he is also an illustrious proof of what the exertions of a single individual can effect, when, unfettered by theory or system, they are steadily directed to the simple unbiassed observation of facts. M. Louis, from the age of seventeen to thirty-three, studied and practised medicine in Russia with considerable success. Gifted with a naturally active and inquiring mind, the multitude of opinions contrasted with the paucity of facts, could not fail to create great dissatisfaction and uncertainty as to the validity of many of the principles most generally admitted, and on which much of our practice was founded.

Accidental circumstances at the close of this period bringing him to Paris, he soon became acquainted with and eagerly studied the writings of the celebrated Broussais, at the same time assiduously following that distinguished pathologist, both in the hospital and lecture room. The impression produced upon his mind by this direction of his studies, was, that while M. Broussais evidently proved others to be wrong, he was very far from demonstrating himself to be right ; that while he rendered palpable the doubts which might reasonably be entertained respecting many of our present principles, he had failed to substitute any thing more satisfactory in their place. From this moment M. Louis resolved to devote himself exclusively to observation, solely actuated by a desire to relieve oppressive doubt and uncertainty, and with no intention of ever giving publicity to his labors. He at once decided on xxx translator's introduction.

remaining at Paris, as affording the best opportunities for prosecuting his intentions, and entered the hospital of La Charite as a clinical cleric, under his friend Professor Chomel. For nearly seven years, including the flower of his bodily and mental powers (from the age of thirty-three to forty), he consecrated the whole of his time and talents to rigorous impartial observation. All private practice was relinquished, and he allowed no considerations of personal emolument to interfere with the resolution he had formed. For some time his extreme minuteness of inquiry and accuracy of description, were the subjects of sneering and ridicule, and cui bono was not unfrequently and tauntingly asked. The absence of any immediate result seemed for a time to justify their contempt of a method involving too much labor and personal sacrifice to be generally popular or easily imitated ; and M. Louis himself, at moments, almost yielded to the increasing difficulties of the task he had undertaken. No sooner, however, were his facts sufficiently numerous to admit of numerical analysis, than all doubt and hesitation were dissipated, and the conviction, that the path he was pursuing could alone conduct him to the discovery of truth, became the animating motive for future perseverance. Many of the results to which he arrived soon attracted general attention, and among those who had formerly derided bis method while they admired his zeal, he found many to applaud and a few to imitate. From this moment may be dated, the presence of that strong impression of the necessity of exact observation, by which the school of Paris has been since so distinguished, and which is now gradually pervading the medical institutions of the continent and our own country : it is undoubtedly to the author of the present volume, that we ought to ascribe the practical revival of that system, which had for ages been verbally recognised but

TRANSLATOR B INTRODUCTION. XXXI

never before rigorously exemplified. For the last five years lie has been physician to the hospital of La Pitie ; the number of advanced students (principally English, American, and German), who follow his visits and clinical lectures, are the best testimonies to the indefatigable zeal and talent with which he still pnrsues his investigations, and, contrasted with the now deserted wards of M. Broussais, forms a practical illustration of the striking change which has been effected in the spirit of medical inquiry.

With no preconceived views of his own to establish (and we believe, no one who has, will observe seven years !) all results from such researches cannot fail to address themselves to our confidence, and in the present instance they have not only the additional value of having been made at a period of life when the judgment is matured and fancy regulated, but by one who, so to speak, began his studies after several years practical experience of their difficulties. He regarded each individual example of disease, as a problem which could only be solved by patient and exact observation ; with this conviction, he studied all the functions during life, from the commencement of the disease to its termination ; for the same reason he examined all the organs after death ; and when attempting to arrive at any general conclusion, he not only analyzed the facts he had collected relative to that disease, but submitted them to a rigorous comparison with other diseases which were at all analogous. It is evidently one thing to determine the series of symptoms, or alterations of structure, which are present in any particular affection, and another to discover what symptoms or alterations are special and characteristic : the one is obtained by confining ourselves to the disease itself; the other can alone result from comparison. A very short time was sufficient to make the discovery that

XXXII TRANSLATOR S INTRODUCTION.

observation was immensely difficult, a fact which authors have hitherto overlooked, thus plainly proving that they themselves observed incompletely. The power of correct observation is not the attribute of ignorance, but is ceteris paribus, always proportionate to the knowledge the individual possesses. With what additional profit and success does the painter, the sculptor, the naturalist, observe after a long cultivation of their respective arts, and how numerous are the details detected, which would wholly escape the unpractised novice ? Now, if an accurate conception of external characters, when passive under the eye of the observer, demands long and patient exercise for its acquirement, how much greater must be the difficulties surrounding the complicated machine of the human frame, under all the varied influences and the innumerable modifications of which it is susceptible ? The phenomena are not only complex and ever varying, but they must often be examined through the distorting medium of a suffering and fanciful mind, and are frequently described with the intention to mislead and deceive. Not to be continually the dupe of such sources of fallacy (and the most practised do not always escape), requires long habit and extensive general knowledge, and no one can have apprenticed himself, as the author in his preface remarks, to the trade of minute and rigorous observation, without a deep conviction of the difficulties attending it and the necessity of long continued perseverance.

We are the more anxious to insist on the great difficulty and infinite importance of observation in medicine, since the very impression is an element of success, and of that caution we should never be free from, in the accumulation of facts, by which our own opinions and those of others are to be regulated. The general habits of our schools and hospitals render

TRANSLATOR S INTRODUCTION. XXXIU

the warning still more necessary ; for while observation is nominally recommended to the student, and even sometimes pursued with zeal and partial success in the first years of his medical studies, it is too often thrown aside with the character of student, at a moment when he is just beginning to acquire the power of observing correctly. The very fact that the task is, in the majority of instances, imposed upon those just entering their career, is calculated to impress the mind with a very imperfect and insufficient idea of its importance. The student should be taught as well as allowed to observe, and the results of his first attempts exposed to the strict scrutiny of a master, who has not himself relinquished the occupation. He should be habituated to analyze and compare the cases he has collected : the time and attention necessary for even a small number of facts, to reduce them to order and trace their relations, would convince him of the difficulties he at first little anticipated, and at the same time impress him with the importance of the results a more extensive and correct application of the method would insure.