A manual of medical treatment or clinical therapeutics

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Preface To The First Edition

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Tar object of this work is the study of disease from the point of view of treatment, The teaching of Therapeutics is here approached from the side of the disease, and not from the side of the drug or remedy —a method which has been thought more natural and more interesting than the one usually adopted. It has not, however, been attempted to discuss questions of treatment apart from considerations of the clinical history, course, and pathological characters of each disease.

Tt is clear that any, or every part, of the natural history of a disease may bear, directly or indirectly, on its treatment, but some parts far more than others; and it would be most unphilosophical and unedifying to discuss the therapeutica of a disease without, at the samo time, considering the true nature of the phenomena we are endeavouring to control.

Tt is by examining into the mode of causation of disease, by investigating the true nature of the morbid changes which underlie the phenomena of disease, and by an exact knowledge of the properties and mode of action of the agencies we introduce for the purpose of influencing favourably its course, that vili Mspicat Trearment.

what are termed rational indications for treatment are arrived at.

These indications are based on observed facts; they have no concern with dogmas of any kind

" Dogmatic medicine, no matter by what name it is known, is a thing of the past. It is wholly inconsistent with scientific methods, and it would be an unjustifiable waste of time here to discuss it. It will continue to have an attraction for certain minds, and that attraction will be found to be quite independent of the ordinary processes of reasoning, or the ordinary laws of evidence.

It hag been the Author's aim in the following pages, wherever it was possible, to deduce rational indications for treatment from an examination of the pathological nature and the clinical course and characters of the disease under discussion ; and if to discover and state such rational indications for treatment is all that is needed to render the practice of medicine scientific, then he ventures to hope that the study of the following pages will show, that the art of healing at the end of the nineteenth century is founded, to a very large extent, on a sound scientific basis.

A work having so wide a scope has naturally occupied the Author’s thoughts for some years, and many chapters are founded on clinical lectures, devoted especially to the consideration of therapeutic questions, which it has been his duty, from time to time, to deliver in King’s College Hospital.

PREFACE. ix

The outlines of Part TV., on the treatment of Phthisis, were sketched and much material for its composition was collected during the period when the Author was one of the physicians of the Brompton Hospital.

At the time the writing of this work was begun Dujardin-Beaumetz was publishing in Paris his “Legons de Clinique Thérapeutique,” a work which lax met with much success, and which was almost the only one then in existence which treated of therapeutics from the samo point of view as is here adopted, Recently Hare's “System of Practical Therapeutics” has appeared in America —a very elaborate and valuable work—and, in England, Prof. Whitla's excellent “Dictionary of Treatment.” The Author's method differs somewhat from all of these; ho has endeavoured to avoid the tedious digressions, especially in the foot-notes, which add #0 greatly and unnecessarily to the bulk of the first-named treatise, and the élaborate and encyclopmdic nature of the second work greatly exceeds the strict limitation to the subjects of Clinical Medicine which, from the outwet, he proposed to himself; nor are the following pages intended for “rapid reference”; on the contrary, they ask for thoughtful consideration. Nothing could be more alien to rational therapeutica than the treatment of disease by “rapid reference”! It ix not in this way that rational indications for the treatment of disease aro arrived at, any more than are the data for accurate diagnosia x MevicaL TREATMENT.

Selections of formule, published for tho most part by well-known physicians, are added to most of the chapters, for the purpose of giving completeness and breadth of view to the subject.

A word of caution may not be here out of place with regard to the modern tendency to adopt new remedies, some of them potent chemical agents, merely on the recommendation of their manufacturers, Serious consequences have resulted from this unwise haste to employ drugs of which we cannot be said to possess any accurate knowledge.

In conclusion, the Author has to express his indebtedness to his colleague, Prof. Watson Cheyne, for kindly looking over the many necessary references to surgical methods.

4h Hertford Street, Mayfair, June, 1898.

Preface To The Second Edition

Tue rapid exhaustion of the frst impression of this work has neccssitated scarcely any change in this Edition beyond the correction of a few trifling errors in the text. It, however, affords the Author an opportunity of expressing his gratification at the very favourable reception it has obtained.

January, 1894.

Preface To The Fourth Edition

Owine to the rapid exhaustion of three large Editions of this work, thé Author has had no opportunity until now of making any serious revision of the text. This the-Fourth Exition has, however, been carefully revised, and although no considerable alterations or additions have appeared to be called for, certain suggestions of friendly eritics have been adopted, and especially the printing of the formule has been altered to meet the needs of students preparing for examination. Those in the first chapter are printed without any abbreviation, solely for educational reasona. In the chapter on Diphtheria recent researches have been carefully noted, and the same remark applies to other subjects on which any new and trustworthy observations have been published. Tt only remains for the Author to offer his best thanks to his critics and to the profession generally for the very flattering reception they have given this work,

Jaanary, 1895.

Part I. THE TREATMENT OF DISEASES OF THE ORGANS OF DIGESTION. our, — rage

L—Tae Treatment or Diszaszs or Tue Mots, Tonsits, AND PoaRyex . oe er ee ee . we oo UF TL.—Tae Treatwent or Diseases or Tue sormacts, . _ wo LUL— Diseases of The Sromach—THE TREATMENT OF ACUTE AND Cmrosio Gastmic CatapRe 2 ewe . ee 8 1V.—Dweases or Tue Stomach—Tur TreaTuxnt or Utcen or ‘THE STOMACH AND oF CaNCER OF THE BromACH . . - & ‘V.—Diseaszs oF THE StomacH—THE TREATMENT OF DILATATION or THE Stomace, om Gastao-rcTasigs . |e ~ . 6 ‘VI.—Disgaszs ov Tae StomacH—rux TreaTwEnt of Hemateumem, Vomrriva, amp Gasraatoia . Poe ae De | ‘VII.—Duweases oy THE Stomach—Tue TaeaTwent oy Dvsrersia. 148 VINL—Drexases o rae Leresrivms—ran Taxarumwt oF Exrsnalas on CoLio ae ah Hie og . rn + + 168 1X.—Diseases ov rae Leresries—tae Trearweet or HasiroaL Comsat 2 ww . . 4 + + 1h X.—Dimuases or rue Iwresrines—rax Tazarwxnt or DIARRiice, om Ieresrimat Oaranen, AcurE AwD Canomio . . |. O08 XL—Dweases oF Tae Lerestives—rox Treatwent oF Arrexprom, Trrsuims, Prarrrra.iris, amp oy Dysexreny . 224

CONTENTS.

Part I.

THE TREATMEST OF DISEASKS OF THE ORGANS OF DIGESTION aur, — race L—Tue Tararwxst oF Drexuues of tux Movrm, Tossa, as Fairies) os a!

VIL—Disexses or rmx Bromacn—rux Tacaruaer or Dyarcraa VIN —Doezasms or rue Ixresrixme—tux Texarmner or &: DORM STMAR ME GUE one ee dy we | Se iy 1X, —-Dimeares or Tox Deresrixes—tue Thxanemrs ov Hanrrvas Cosmmranion 2. Peck x yh: X— Denese op tee lerecines—rie Tararwest or Dianneca, OM Isreeroat Carasen, Acure ayo Cunomo . . 31 —Daeane oF cae Lereriee—rue Txrantet or Avro proms, Tyrer, Poerrrucrna, asp ox Drsestexy xiv MepicaL TREATMENT.

cur Paan

‘XIL.—Diseases ov Tax Leresrives—tae TazaTwent or Letestival: Ossrrnvotion «see . te pe ee Se oe MP

‘XII1.—Diseases ov rmx Leresrores—rue Taearwext oF Ixresrinat. Parasimm. 6. 6 6 ee see ee 888

XIV.—Diseases oy Toe Inresrines—rue TaeaTumxt ov Pent rome ewe ee ee