A treatise on the theory and practice of medicine

Front matter

THE

THEORY AND PRACTICE OF MEDICINE.

WORKS ON PRACTICE,

Preface To The American Edition

enclosed in brackets [ — ]. They have been made in harmony, as far as possible, with the general plan of the work, and it is earnestly hoped that they will not be thought unworthy of the place they occupy.

J. H. H.

2019 Walnut Street, Philadelphia, September 26th, 1876.

PEEFACE.

In placing this work before those for whom it was especially written, namely, the junior members of the profession and students in Medicine, I may be permitted to make a few preliminary remarks, partly by way of explanation, partly by way of acknowledgment, partly apologetic.

The first thought, as I suppose, of every one who sits down to write a scientific book is bestowed upon the arrangement of his matter. It was my first thought. The classification of disease, moreover, is a subject to which I have devoted a good deal of attention. But I had long formed the opinion that it is impossible, in a work on Medicine, intended to be practical, to arrange diseases on strictly scientific principles ; and in this opinion further consideration of the matter only confirmed me. Consequently the arrangement which I have adopted is for the most part artificial, and to be defended only on grounds of convenience. Certain affections I have grouped together as " Specific Febrile Diseases but all others, with in many cases more or less disregard of accuracy, have been classified as Local Diseases. I may add that, in respect of the diseases of individual organs, I have for the most part arranged them, though without expressly indicating the fact, in the following order, namely, Inflammations, Morbid Growths (including Tubercular and Syphilitic Formations), Parasitic Diseases, Degenerations, and Mechanical and Functional Affections. I have not hesitated, however, in many instances, to depart from this arrangement.

The selection of subjects to be discussed in a treatise intended to occupy a moderate compass is by no means easy. Medicine is inextricably interwoven with Surgery and with what it is now fashionable to term " gynaecological medicine.' 7 Moreover, several other departments of practice, especially perhaps insanity, are now relegated to specialists, and have attained such importance as to need special hospitals, and to have a literature of their own. And again, many diseases, and more particularly local diseases, which doubtless have a substantial existence,

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are either not recognizable by specific symptoms during life, or are of very trivial importance, so that it would be a waste of time and space even to enumerate them. I trust that, under such circumstances, I shall be pardoned for having treated some important subjects superficially, for having omitted many subjects that it may seem to some persons that I should have included in my work, and for having occasionally introduced topics which may appear to be beyond the sphere of Medicine in the restricted sense of that term.

In discussing each subject, and more especially in discussing each disease, my aim has been to give in a readable form as much information as I could include within a limited space. With that object, my practice has been in every case to read the subject up carefully, to compare the knowledge thus acquired or renewed with the results of my own experience, in those cases in which I had any experience, and then, having taken a more or less definite view of the whole subject, and while my mind was still full of it and of its details, to write as clear and as comprehensive an account as I was capable of. Each article may therefore be regarded as expressing in a condensed form the fulness of my knowledge of its subject at the moment at which it was written. This method of procedure will partly explain both the ex cathedra tone in which I have, I believe, generally expressed myself, the prevailing absence of notes, quotations, and references to authorities, and perhaps also many inaccuracies and omissions.

I have, throughout the work, given particular prominence to the pathology and to the clinical phenomena of disease ; and in all cases in which the clinical phenomena seem to be the direct consequences of definite lesions (especially, therefore, in the case of local diseases) my account of the morbid anatomy has been made to precede the clinical description. It may possibly, however, seem to be an omission that I have only occasionally devoted a special paragraph to the differential diagnosis of diseases. It is so far an omission that I have been driven to it by the exigencies of space. But on the whole I do not regret it ; for the distinguishing of one disease from another disease should depend, not on the simple recognition of a few leading characters, which, however carefully selected, are apt not unfrequently to fail us, but on a bona fide and thorough acquaintance with the collective phenomena of diseases. The more a student is taught to rely on one or two criteria, the less likely is he to investigate diseases intelligently, and the more apt is he to be content with hasty and inaccurate diagnoses.

PREFACE.

ix

In respect of the treatment of diseases, again, I may appear to have been in many cases less full and less specific than I ought to have been. The principles by which I have been guided in this matter are easy to explain. In the first place, it seemed to me that works upon the Materia Medica are the proper source from which to learn the doses in which medicine may be administered, and the best modes of combining medicines. And in the second place, in considering the details of treatment, as given in most works of medicine, it appeared to me that their authors had for the most part simply recommended those doses of drugs, those combinations of drugs, and those specific methods of administering them, to which they had accustomed themselves. I admit that the subject of my last objection will be regarded by many from quite an opposite point of view. Nevertheless, while, on the one hand, I should hesitate to force my own routine and trivialities of practice upon students, I should equally hesitate to force upon them those of other people. It seems to me best, having inculcated general principles, and pointed out the specific virtues of certain drugs, to leave the young practitioner generally as much unshackled as possible with regard to his choice of particular combinations and modes of administration. He is far more likely to make a thoughtful physician and, as I think, to benefit his patient, if he adapts his drugs and his methods to the exigencies of cases as they present themselves before him, than if he follows the stereotyped procedure of some predecessor.

From first to last I have carefully avoided quoting illustrative cases. This course has been forced upon me by the necessity under which I labored of compressing my work within the narrowest possible limits of space. But it is a course which I adopted reluctantly, and with the full knowledge that I was thereby robbing my pages of much that might have been instructive, of much, at any rate, that would have rendered them pleasanter reading. Every one who has perused them knows how much of the charm, the freshness, the vigor, the impressiveness, and the permanent interest that characterize the classical writings of Abercrombie, of Graves, of Watson, of Trousseau, and of other masters of our art depend upon the well-told cases with which they are so richly interspersed.

I have already referred to the omission to quote authorities of which I have been generally guilty. The excuses which I have to offer, in reference to this matter, are mainly the following : I was anxious to economize space ; I felt, moreover, that my work was not an encyclo-

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psedia, still less a history, of Medicine ; and again, many important additions which have been made to onr knowledge, even during the last few years, have already become classical, and form an integral part of the great body of Medical Science. My indebtedness, however, direct or indirect, to innumerable writers and workers I most fully acknowledge; and among these I must not fail to include my senior colleagues and former teachers of St. Thomas's Hospital, the value of whose teaching to myself I cannot exaggerate. But there are certain works on which I have drawn very largely, and to the authors of which on that account I owe special gratitude; these are, in pathology and morbid anatomy, Rokitansky's Pathological Anatomy, Cornil and Ranvier's Manual of Pathological Histology, and Virchow's writings, including, above all, his marvellous work on the Pathology of Tumors; in general medicine, Sir T. Watsou's Lectures on the Principles and Practice of Physic, Reynolds's System of Medicine, Aitken's Science and Practice of Medioine, Niemeyer's Elements of Internal Pathology and Therapeutics, and Trousseau's Cliniccd Medicine ; and, in special subjects, Duchenne's admirable work on Localized Electrization, and the no less admirable Lectures by Charcot, on the Diseases of the Nervous System.

I must apologize for the many omissions, errors, redundancies, and other faults with which I am only too conscious that my work abounds. Fresh from its completion, I feel, perhaps not unnaturally, how much better I could do it were I, from the standpoint of my present experience, now to rewrite it. But this is perhaps a delusion. At any rate, I can only take credit for what I have done, and not for what I conceive myself capable of doing. The tree must be judged by its fruits.

In conclusion, I beg leave to record my sincere thanks to my friends, Drs. H. Don kin and Greenfield for the kind and valuable assistance I have received from them in the progress of this work through the press. They have each read and criticized nearly every page ; and I owe it to them that many mistakes have been corrected, many omissions supplied, and that the reader has been spared the infliction of some grammatical inaccuracies and no little careless spelling.

II Old Burlington Street,

August, 1876.

Part I. Page

GENERAL PATHOLOGY, .... 17

Predisposing Causes, ... . . . . . . . .22

Age; sex; personal peculiarities; occupation, habits, etc.; previous disease ; heat and cold, etc. Epidemic constitution. Change of type of disease.

Mechanical; chemical; vital— parasites, contagia, malaria, etc.

General Account of Physiological Processes in Health, . 32 Properties and development of protoplasm. Simple tissues — epithelial, connective, tubular ; organs. Development, growth, and maintenance of the organism. Functions of circulatory system ; of digestive system ; of excretory system; of nervous system. Decay and death essential elements in the processes of life.

Physiological Process in Disease, 37

I. Morbid Growth, 38

General Observations, . .... . ... . .38

Growth and development of cells. Conditions associated with overgrowth. Migration of leucocytes. Tendency of morbid growth to spread locally. Tendency of morbid growth to become generalized. Tendency of certain morbid growths to iimit their distribution to certain tissues or organs. Connection of dyscrasia with the origin of morbid growths. Secondary dyscrasia. Meaning of terms "malignant" and "innocent."

General account. Extra vascular processes — in cartilage, in mesentery, in cornea, in the vascular tissues. Vascular processes. Exudation. Suppuration. Destructive processes — ulceration, gangrene. Organization, granulation, and cicatrization. Spread. Constitutional effects. Varieties. Classification of Tumors, ........... 61

General account.

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CONTENTS.

PAGE

Connective-tissue Tumors (Group 1), . . . . . . . .63

1. Fibrous tumor, or fibroma. 2. Fatty tumor, or lipoma. 3. Mucous tumor, or myxoma. 4. Glue-like tumor, or glioma. Cartilaginous Tumors, or Chondromata (Group 2), . . . . .65

Eccbondroses ; enchondromata.

Osseous Tumors, or Osteomata (Group 3), .66

Ivory ; compact ; spongy. Exostoses. Enostoses. Odontomata. Nervous Tumors, or Neuromata (Group 4), . . . . . .66

Muscular Tumors, or Myomata (Group 5), . . . . .67

Vascular Tumors, or Angiomata (Group 6), . . . . . .67

Simple; cavernous.

Lymphatic Tumors, or Lymphomata (Group 7), . . . . .68

1. Lymphangioma. 2. Lymphadenoma (lympho-sareoma) ; simple inflammation ; scrofulous enlargement ; lympbadenoma ; leukasmia or leueocytbsemia.

Tubercle and Granuloma (Group 8), . . . . . . . .73

1. Tubercle: gray or miliary; caseous or yellow. Connection between tubercle and adenoid tissue. Relations between gray and yellow tubercle. Quasi- malignancy of tubercle. Experimental inoculation. 2. Syphilitic gummata.

Sarcomata (Group 9), 79

1. Round-cell sarcoma. 2. Spindle-cell sarcoma. 3. Large-cell sarcoma. 4. Melanoid sarcoma. Psammoma.

1. Scirrhus or hard cancer. 2. Encephaloid cancer; erectile or hsematoid, pultaceous, lipomatous, melanotic. 3. Colloid cancer. 4. Epithelioma or cancroid. 5. Adenoid or tubular cancer.

II. Atrophy, Degeneration, and Necrosis, 87

General Remarks. 1. Cloudy swelling. 2. Mucous and colloid degeneration. 3. Lardaceous degeneration. 4. Fatty degeneration. 5. Pigmentary degeneration. 6. Uratic degeneration. 7. Calcareous degeneration. Necrosis or Gangrene.

III. Mechanical and Functional Derangements, 96

a. Mechanical Derangements, .......... 96

1. Displacement of parts. 2. Compression, contraction, and impaction. 3. Dilatation. Cysts: cysts by dilatation of natural cavities ; cysts by distension of ducts or retention ; cysts by extravasation ; cysts by softening of tissues. 4. Rupture and extravasation.

b. Functional Derangements, . . .100

Active, passive.

Local, general.

Normal temperature. Conditions which determine and regulate beat of body. Febrile temperature. Hyperpyrexia. Symptoms attending febrile temperature. Condition of skin ; of circulation ; of respiration ; of digestive organs ; of urine ; of nervous system. Cause of death in fever. Causes of the febrile temperature. The thermometer.

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Hectic Fever, . • • » • .113

The Typhoid Condition, 114

Symptoms. Causes.

Collapse. Syncope, . . . . • . • • • • .116 Symptoms of collapse. Symptoms of syncope. Depression of temperature. Feebleness of circulation. Condition of nervous functions.

Death, . 118

From failure of nutrition. From failure of the circulation. From failure of the elimination of effete and poisonous matters. From failure of the nervous system to perform its appropriate functions.

Hygienic Treatment, ........... 123

Prophylactic Treatment, . . . . . . . . . .123

1. Prophylaxis in relation to the tendency, inherited or acquired, to disease. 2. Prophylaxis in relation to parasitic, endemic, and infectious disease. 3. Prophylaxis in relation to the complications or sequelae of disease.

Remedial and Therapeutical Treatment, ....... 125

1. Protection of sick from injurious influences. 2. The maintenance of the patient's strength. 3. The maintenance or improvement of the nutritive functions. 4. The elimination of effete matters. 5. The treatment of symptoms. 6. The obviation of the tendency to death.