Clinical lectures on the principles and practice of medicine

Front matter

The Library of the Wellcome Institute for the History of Medicine

MEDICAL SOCIETY OF LONDON DEPOSIT

Accession Number Press Mark

Preface

This Second Edition of my Lectures on Clinical Medicine has been greatly extended, and the matter arranged in a more condensed and systematic form. Throughout, I have endeavoured to show the correctness of the principles which have guided my practice by reference to indisputable facts. Hence, every case is authenticated with the name of its reporter in the hospital books.

I have availed myself of numerous illustrations engraved on wood, having been long persuaded that mere description of morbid appearances, and especially of those that are made visible by means of the microscope, communicate only feeble or imperfect ideas to others. Of these illustrations, such as are borrowed have the names of their authors appended ; such as have no name attached are original.

To numerous friends (many of them former pupils) I have to express my warmest thanks for aid rendered to me in various ways. But my acknowledgments are especially due to Dr. John Glen, late Resident Physician in the Infirmary, vi PREFACE.

for the time and labour he has bestowed in verifying the accuracy of the statistics of Pneumonia ; for the assistance he lias afforded me in the compilation of several cases, and for the correction of many sheets during their progress through the press.

Notwithstanding the care which has been bestowed on this work, I am fully aware that it must be imperfect ; for to illustrate the entire subject of practical medicine by means of cases in a work of moderate compass, is obviously impossible. Still, sufficient examples, I trust, have been given to illustrate the more important modifications which the advanced state of diagnosis and pathology has effected in the treatment of diseases. I have only to add, that it will give me sincere gratification should I succeed in conveying to others the conviction I myself entertain, that such modifications will be shown by further experience to be not merely temporary changes, but permanent improvements in the practice of the art.

J. HUGHES BENNETT.

Edinburgh, February 1858.

Contents

Page

List of Illustrations ....... xv

Introduction ........ 1

SECTION I. Arrangement of symptoms, etc. ..... 18

Inspection of the dead body ..... 22

Relative position of internal organs .... 26

Inspection ........ 28

Inspection of the general posture .... 28

of the countenance ..... 28

of the chest ...... 29

of the abdomen ..... 30

Increased or diminished sensibility of parts ... 31

Altered form, size, density, and elasticity t 31

Alterations of movement ...... 31

Mensuration ........ 32

Percussion ........ 35

Of the different sounds produced by percussion ... 37

Of the sense of resistance ...... 38

General rules to be followed ..... 38

Special rules to be followed in percussing organs . . 41

in percussing the lungs . . 41

in percussing the heart . . 44

in percussing the liver . 45 viii

CONTENTS.

Page

Special rules to lie followed in percussing the spleen . . 47

in percussing the stomach and intestines 47

in percussing the Madder . . 49

Auscultation «>0

General rules to he followed ..... 50

Special rules to he followed ..... 52 Of the sounds elicited hy the pulmonary organs in health and in

disease °3 Special rules to he followed during auscultation of the circulatory

organs *6 Of the sounds elicited by the circulatory organs in health and

disease *>7

Auscultation of the abdomen ..... 60

Auscultation of the large vessels . 60

Use op the Microscope . • • • • • 61

Description of the microscope ..... 63

Mensuration and demonstration . 70

How to observe with a microscope .... 72

Principal Applications op the Microscope to Diagnosis . • 75

Saliva 75

Milk 77

Blood 79

Pus 81

Sputum 82

Vomited matters 8^

Fceces .' £ . . • • • \ 87 Uterine and vaginal discharges .

Mucus '• 89

Dropsical fluids 90

Urine 91

Cutaneous eruptions and ulcers . 94

Use of Chemical Tests 97

To detect albumen in the urine 97

To detect bile in the urine ..... 97 To detect sugar in the urine ...

To detect chlorides in the uriue . 98

SECTION II. On the General Laws op Nutrition in llEALTn and Disease . 102

Function of nutrition

General pathology and treatment of diseases of nutrition . 1 10

Function of innervation . . • • • ' 1 "

CONTENTS. IX

Page

"General anatomy and physiology of the nervous system . . 112

General pathology of the nervous system . 120 Simple, Cancerous, and Tubercular Exudations, theiu Pathology and

Production of exudation . . . . . . 129

Theory of exudation . . . . . . 131

Vital transformations of the exudation . . . . 134

Simple exudation . . . . . . 134

Cancerous exudation ...... 139

Tubercular exudation ...... 143

Pathology of the three kinds of exudation . . . 144

Death of the exudation ...... 148

Mortification or moist gangrene . . . . 148

Ulceration ....... 151

General treatment of exudation ..... 153

Morbid Growths of Texture, their General Pathology and Treatment ........ 155

Classification . . . . . . . 156

Fatty growths ...... 166

Glandular growths ...... 177

Vascular growths ...... 190

Cartilaginous growths ..... 194

Osseous growths ...... 198

Cancerous growths ...... 204

General treatment of morbid growths . . . . 216

Morbid Degenerations of Texture . . . . . 218

Mineral degeneration ...... 243

Albuminous concretions ...... 247

Fatty concretions . . , . . . 248

Pigmentary concretions ...... 248

Mineral concretions ...... 248

Urinary concretions ...... 249

Prostatic concretions ...... 252

Hairy concretions ....... 253

Vegetable fibrous concretions ..... 254

Amyloid and amylaceous concretions .... 256

X

CONTENTS.

SECTION III. Page

ON THE RECENT CHANGES IN THEEAPEUTICS, OCCASIONED BY AN ADVANCED KNOWLEDGE OF DIAGNOSIS AND PATHOLOGY 259

The Diminished Employment of Blood-letting and othee Antiphlogistic Remedies in the Treatment of Acute Inflammations . 260

Proposition 1. — That little reliance can be placed on the experience of those who, like Cullen and Gregory, were unacquainted with the nature of, and the mode of detecting, internal inflammations 261

Proposition 2. — That inflammation is the same now as it has ever been, and that the analogy sought to be established between it and the varying types of fevers is fallacious . . . 263

Proposition 3. — That the principles on which blood-letting and antiphlogistic remedies have hitherto been practised are opposed to a sound pathology . . . . . . 266

Proposition 4. — That an inflammation once established cannot be cut short, and that the only end of judicious medical practice is to conduct it to a favourable termination . . . 274

Proposition 5. — That all positive knowledge of the experience of the past, as well as the more exact observations of the present day, alike establish the truth of the preceding principles as guides for the future ....... 279

The Influence of Predominant Ideas on the Healthy and Disordered

Functions of the Body ...... 289

SECTION IV. On the Pathology of Ceredral and Spinal Softenings, and on the

Necessity of employing the Microscope to ascertain their nature 303

Acute Hydrocephalus — Cases I. to III. . . . . 311

Cerebral Meningitis, Acute — Cases IV. to VI. . . . 317

Chronic— Cases VII. and VIII. . . 325

Cerebritis, Acute — Cases IX. and X. . . . . 329

Chronic— Cases XL to XIV. .... 333

Pathology and treatment of cerebritis .... 342

Cerebral Disease from Obstruction of Arteries — Cases XV. to XVII. 345

Cerebral Hemorrhage — Cases XVIII. to XXVIII. ... 357

Puthology and treatment ...... 374

CONTENTS. Xi

Page

Cancer op the Brain — Case XXIX. ..... 379

Dropsy op the Brain — Case XXX. ..... 382

Structural Diseases of the Spinal Cord — Cases XXXI. to XXXVI. 386

Treatment ...... 390

Functional Disorders op the Nervous System — Case XXXVII . 399

Classification of functional nervous disorders . . . 401

Pathology of functional nervous disorders . . . 403

Treatment of functional nervous disorders . . . 407

Delirium tremens— Cases XXXVIII. to XLI. ... 409

Poisoning by opium — Case XLII. .... 412

Poisoning by hemlock — Case XLIII. .... 413

Poisoning by lead — Case XL.IV. . . . . . 41 8

SECTION V. Diseases of the Mouth, Pharynx, and (Esophagus — Cases XLV. to

XLIX 421

Functional Disorders of the Stomach — Cases L. to LII. . . 429

General pathology and treatment of dyspepsia . . . 432

Vomiting of sarcinse — Cases LIU. and LIV. . . . 436

Organic Diseases op the Stomach ..... 439

Chronic ulcer of the stomach — Cases LV. and LVI. . . 439 Chronic ulcer of the stomach, with perforation — Cases LVII. and

LVni. 441

Cancer of stomach — Cases L1X. and LX. . . . 449

Acute congestion — Case LXI. ..... 454

Jaundice— Cases LXII. and LXIII. .... 454

Jaundice from cancer compressing the ducts — Cases LXIV. and

Enlargement of the liver— Case LXVI. .... 463

Fatty enlargement— Case LXVII.' .... 464

Cirrhosis— Cases LXVni. and LXIX 467

Cancer of the liver — Case LXX. ..... 472

Diarrhoea— Cases LXXI. and LXXII. .... 476

Dysentery— Cases LXXIII. to LXXV 478

Pathology and treatment of diarrhoea and dysentery . . 482

Obstruction of large intestine from cancer — Case LXXVI. . 486 Strangulation of small intestine from inguinal hernia — Case

LXXVII . 488 xii

CONTENTS.

Page

Intestinal Worms— Cases LXXVIII. to LXXX. . 492

Peritonitis— Cases LXXXI. to LXXXIII. .... 499

SECTION VI. Pericarditis— Cases LXXXIV. to LXXXIX. . . . . 511

Valvular Diseases of the Heart — Cases XC. to C. . . 530

Enlarged foramen ovale — Case CI. .... 545

Pathology of valvular and organic diseases of the heart . . 547

Treatment of valvular and organic diseases of the heart . . 553

Functional Disorders of the Heart ..... 554

Aneurism — Cases CII. to CIX. ...... 555

General diagnosis of thoracic aneurisms .... 583

Physical phenomena of ahdominal aneurism . . . 586

Pathology and treatment of aneurisms .... 586

SECTION VII. Laryngitis— Cases CX. to CXIII. ...... 589

Treatment hy topical applications . . . . 591

Diagnosis of laryngitis ...... 597

Bronchitis— Cases CXIV. to CXVIII .599

On injections of the bronchi in pulmonary diseases . . 608

Pleuritis— Cases CXIX. to CXXI. . . . . . 610

Pathology, diagnosis, and treatment of Plcuritis . . . 615

Empyema— Cases CXXII. to CXXrV. .... 622

Pneumonia— Cases CXXV. to CXXXII. .... 627 On the diagnostic value of the absence of chlorides from the urine in

pneumonia — Case CXXXIII. .... 637

General pathology and treatment .... 610 Chronic pneumonia and gangrene of the lung — Cases CXXXIV. to

CXXXVH 643

rnTiiisis Pulmonale— Cases CXXXVIII. to CXLIV. . . 652

On tlio curability of phthisis pulmonalis — Case CXLV. . . 670

Pathology and general treatment of phthisis pulmonalis . . 674

Special treatment of phthisis pulmonalis .... 683

Cancer of the Lung— Case CXLVI. ..... 688

Carwwaceous Lungs— Cuscs CXLVII. and CXLVIII. . . 691

Pathology and trcatmont ...... 693

CONTENTS.

xiii

SECTION VIII. Page

Ovarian Dropsy— Cases CXLIX. to CLI. .... 698

Pathology of ovarian dropsy ..... 714

Treatment of ovarian dropsy . 718

Nephritis and Pyelitis — Cases CLII. and CLIII. . . . '720

Desquamative nephritis — Cases CLIV to CLVI. . . . 724

Suppurative nephritis — Case CLVII. .... 731

Scrofulous nephritis— Case CLVII1. . . . . 734

Calculous nephritis — Case CLIX. ..... 736

Chronic pyelitis — Case CLX. ..... 739

Pathology of cystic kidney ..... 741

Persistent Albuminuria, or Bright's Disease — Cases CLXI. to CLXIX. 743

Pathology of Bright's disease ..... 759

Diagnosis of Bright's disease ..... 763

Treatment of Bright's disease ..... 766

Section IX. Diseases Of The Integumentary System 7g8

Classification op Skin Diseases ..... 769

The Treatment of Skin Diseases ..... 779

Acarus scahiei ....... 785

Entozoon folliculorum ...... 788

Favus— Cases CLXX. to CLXXV. .... 790

Histoiy of favus as a vegetable parasite .... 794

Mode of development and symptoms of favus . . . 795