Introductory lecture to a course on the theory and practice of medicine : delivered at the Medical School Park Street Dublin / by William Stokes.

  • Stokes, William, 1804-1878.
Date:
[between 1830 and 1839?]
Catalogue details

Licence: Public Domain Mark

Credit: Introductory lecture to a course on the theory and practice of medicine : delivered at the Medical School Park Street Dublin / by William Stokes. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    circulating system ; hurried respiration, and cough, and- hiccup, from the action on the respiratory system ; jaundice, from its action on the biliary system; suppression of the secretion of the skin, kidneys,.&c. All these, you observe, are lesions of the functions of organic life. But we may have other symptoms; prostra- tion, headach, delirium,convulsions; these are lesions of the life of relation, or animal life. Now, in many cases, we have to combine these sources of knowledge to form a correct diagnosis, 'lake, for example, a case of hepatitis. The patient has had pains in the hepatic region, fever, jaundice, hurried breathing, ten- derness. After some time he has a tumour; the side dilated ; the hypochondriam dull on percussion. Well, the signs point out an en- largement of the liver; the symptoms, that the cause of that enlargement was an acute hepatitis. In general we may stale, that signs only declare the actually existing mechanical con- dition, while symptoms,either present or past, point out the cause of the change, whatever it may be. Both must be studied together; but you will learn more from symptoms with- out signs, than from signs without symptoms. But to return to the results of the improved method of investigation. Great light was thrown on fever in general; and it is, I believe, quite true, that all the advances which we have made in the know- ledge of fever, are due to the prosecution of pathological anatomy. Almost all of what we may call our general knowledge of fever is due to Hippocrates; but anatomy has re- vealed its effects, its complications; and the all-important fact, that the cause of its fatality is often local inflammation. This knowledge, however, is not so new as is taught by some modern syslematists. Galen (Dc Affect. In- tern. c. xli,) taught that in continual fevers bleeding and cold drinks were the powerful remedies. Sydenham declares that the ig- norance of the inflammations in malignant fevers, has been more fatal to the human race than the invention of gunpowder. Baglivi, that malignant fevers often depend on a vis- ceral inflammation, and Van Swieten knew the frequency of intestinal ulcerations in typhus. Among the direct results of pathological anatomy, it is shown, that disease in seldom confined to one organ, or even one system, and thus it has utterly shaken the nosological system of Cullen and his predecessors, which you know consisted in classifying disease by symptoms, which were supposed to point out a certain and single disease. For example, the nosologists class phthisis as an affection of the lung, but pathological anatomy has shown, that in many cases it is tlie result of a disease invading many organs and systems, and that the pulmonary disease is but a link in the chain of morbid actions. Pathological ana- tomy also has demonstrated the inflammatory nature of a vast number of diseases, and has thus given us a key to treatment, to pre- vention, and to palliation when the disease is incurable. The last grand result of pathological ana- tomy, is the discovery that a vast number of affections, supposed to be merely lesions of function, are more or less connected also with alteration of structure. Thus many of the dyspepsias of the nosologists are proved to be examples of gastritis, or of other organic dis- eases ; cases of asthma turn out to be chronic inflammation with emphysema; the pal- pitations may depend on organic disease which has sprung from a carditis, and so on. I need not now dilate on the vast importance of such facts to practical medicine. But let us now come to an all-important inquiry. Is pathological anatomy to be con- sidered as the basis of medicine? or is it, even when combined with clinical observation, the foundation of all medical knowledge? This inquiry, you will at once perceive, in- volves the question as to whether Hippocrates and his followers have done anything for the science, or whether medicine is wholly new, an infant, and consequently a weak and im- perfect, science. Are we to despise the works of the ancients, to be ignorant of them, and to allow medicine to be in its infancy. In fact, if we review the history of medicinefrom the Hip- pocratic era to the absurdities of Hahnemann, we find that there have been two orders of men, one constituting what we may term the school founders, who made a theory, and sought to square facts to meet that theory; these have only brought disgrace on medicine. I he other class consists of the Hippocratic observers, that is, of men who sought for facts, who col- lected and pondered on these facts, in other words, who were Baconian philosophers. It is the labour of these that has really advanced medicine. Asclepiades, who lived in the first century of the Christian era, declared that the medicine of Hippocrates was a cold meditation of death. The celebrated I hessalus, who lived under Nero, in writing to the emperor makes use of the following words:— “ I have founded a new sect, which is the only new one. I have been forced to this, because none of the physicians who have pre- ceded me have discovered anything useful, either for the preservation of health or for the cure of diseases, and because Hippocrates him- self has put forward many dangerous maxims.” And what was this new doctrine? That nature in each case pointed out to the patient what was most fit for him, and that hence he should be diligently supplied with every thing that he fancied. We have next Paracelsus. He commenced his course of lectures at Basle, in the year I5‘2G, by publicly burning the writings of Galen and Avicenna, and assured his auditors that a single hair of his head contained more knowledge thin Hippocrates and his successors, lie taught the cabalistic medicine, the intimate