Complete Text (Part 1)

urate o 4 Rew Weed 7 PiLTSBURGH ACA bE PITTSBURGH, my oF MERE 22 North Craig St PAY pa LECTURES ON THE MORBID ANATOMY, NATURE, AND TREATMENT, oF ACUTE AND CHRONIC DISEASES; by THE LATE JOHN ARMSTRONG, M.D. CONSULTING PHYSICIAN TO THE FEVER INSTITUTION OF LONDON; AUTHOR OF “PRACTICAL ILLUSTRATIONS OF TYPHUS AND SCARLET FEVER,” Pre. — % EDITED BY JOSEPH RIX, MEMBER OF THE ROYAL COLLEGE OF SURGEONS IN LONDON. = FIRST AMERICAN EDITION: With an Account of the Bite and Writings of Br. Armstrong, BY JONN BELL, M.D. ANCTURER ON THE INSTITUTES OF MEDICINE AND MEDICAL JURISPRUDENCE, &C. &€. IN TWO VOLUMES VOL. I. . PHILADELPHIA: DESILVER, THOMAS & Co. 1837. c k ioe lelee, Ze Ce re 4 b i fh py = A, My Lae staf all f Nathan lef /hee J a ed me ore {i leur /) * % ~ i for () ft hecad 14 (. Oe 5 rai lb ft a, (4 Lp, L df ae if tvie , { hy — ™ r ay = oO SS . XS BS we SS INTRODUCTION TO THE FIRST AMERICAN EDITION. Tue best introduction to the American edition of the Lectures on the Practice of Physic by the late Dr. Armstrong, will be an account of the Life and Writings of their distinguished author. His career of usefulness and fame adds another to the long list of examples of the comparative ease with which early difficulties and obstructions, in the want of wealth, friends and patronage, are overcome by the persevering efforts of a vigorous intellect and a determined spirit. Doctor Jonny Arusrroxe was born on the Sth of May 1784, at Ayres Quay, in the parish of Bishopwearmouth, in the county of Durham. THis parentage was humble. His grandfather was a husband- man, and his father was a manager of glass-works. The latter, although uneducated, is represented to have been a man of superior abilities, and of so much ingenuity and integrity as to have been highly valued by his employers. But it was to the watchful tenderness and considerate affection of his mother that Dr. Armstrong professes himself to have been chiefly indebted, both for encouragement to professional study and for the means of prosecuting it. The early years of his life were not marked by any precocity of intellect, nor even by a ready acquisition of the common rudiments of learning. When eight years of age, he was unable to read; but this backwardness seemed to be the result of improper teaching rather than of either idleness or inefficiency. At this period he was transferred from the pedagogue, whose labour, if he exerted any, was attended with such barren results, to the care of Mr. Mason, a minister of the United Secession Church of Scotland. With this gentleman he made great Az vi LIFE AND WRITINGS progress, and evinced talents which never after ceased their display ; and it is worthy of mention, as creditable alike to preceptor and scholar, that the latter, after passing eight years at the seminary, seized every hour of leisure during his subsequent stay in Edinburgh as student of medicine, to benefit himself by the lessons of his old teacher. On leaving school, having shown a predilection for the medical pro- fession, he was placed with a Mr. Watson, surgeon and apothecary at Monkwearmouth ; but soon becoming wearied, perchance disgusted with his situation, he left it contrary to the wishes of his parents, and remained at home for two or three years, leading a desultory if not an idle life, His imagination was, however, active enough, during this interval, in forming visionary schemes for his future course ; one of which was to go to London and to seek employment in some literary occupation. But, although he is said to have shown a taste for poetical composition, and to have written several fugitive pieces which attracted the notice of his companions, we may believe that this was a suggestion of vanity rather than the promptings of conscious power, since neither his verses nor his slender literary attainments would have qualified him for becoming a successful adventurer in this line. Be this as it may, this period of comparative idleness in the life of young Armstrong, during which he wandered about Sunderland, wrote fugitive pieces of poetry, and even meditated a tragedy on the story of Boethius, was, if not the most useful, certainly far from being clouded by dullness or unhappiness. The change in the first arrangements, caused by his early wayward- ness, did not lead to an abandonment of the original design ; that he should prepare himself for the practice of the medical profession. Accordingly, at the age of nineteen or twenty, he left home to enter as a medical stu- dent the University of Edinburgh, in which city he ‘resided three years. Tle was enabled to take this step chiefly by the economy and management of his excellent mother, of whom he always spoke in after life with an evidence of the heartfélt sense of the advantages which her self-denial had conferred upon him, He often assured his friend and biographer Doctor Boott, that he owed every thing to her. Still, his supplies were so limited as to compel him to practice a rigid econo- my, and to confine his studies to those essentially requisite for his ob- OF DR. ARMSTRONG. vii taining adegree. He gained this honour in June 1807, having written a thesis “De Causis Morborum Hydropicorum, Rationeque iis Medendi,”’ which was dedicated to John Anderson, Esq. He had previously, on the 5th of May, passed an examination at the Royal College of Surgeons in Edinburgh, and is consequently termed “ CAé- rurgus’’ in the official entry on the University books. His health at this time was so deteriorated as to cause much solicitude to his friends ; and Dr. Boott intimates his belief that evenat this early period hisailments indicated a tendency to consumption. It is, however, no uncommon thing for a studious youth, who debars himself from exercise and trims the midnight lamp, to pay this kind of tax for collegiate honours; and he may be thankful if a return to his kindred and friends be fol- lowed by restoration to health and a renewal ef his buoyant spirits. Doctor Armstrong was, we see, but twenty-three years of age when he took his degree; after three years study and little previous medical education. At the time of his entering the University of Edinburgh, the chief ornament of that celebrated school of medicine was Doctor Gregory, the author of the classical “Conspectus Medicine Theoreti- ce? aman, says Dr. Boott, perhaps more distinguished for elegance of mind than for any originality as a writer. Dr. Armstrong, although admiring his benevolence and urbanity, considered his mode of instruc tion to be too scholastic, and too much devoted to the views of his illus- trious predecessor, Dr. Cullen. A critic on the Life and Works of Dr. Armstrong, in the Bri ish and Foreign Medical Review, whilst bear- ing his own testimony to the wisdom, manliness, and Iearning without pedantry, and the scorn and contempt for quackery, which distinguished Dr. Gregory, expresses his surprise at Dr. Armstrong's preference for Dr. Hamilton, of purgative fame. Te concedes to this latter the merit of showing, that purgative medicines might be safely and advantageously used in various forms of fever and several other diseases, in whieh their administration had been previously considered hurtful or dangerous ; and admits that his precepts concerning this class of medicines are emi- nently judicious, But he avers that Dr. Hamilton’s applications of the purgative doctrine, in his hospital practiee, was indiscriminate ; and attended in many cases, especially of fever, dysentery and inflammatory viii LIFE AND WRITINGS diarrhoea, with such palpable fatality, as none but a practitioner devoted to a single idea could possibly have overlooked. As a feacher of prac- tice, in the course of his hospital duty, a regard for truth compels us to say, continues the critic, that he was little calculated to assist the learner: he was supercilious, never addressed a word of explanation to the stu- dents who followed him up and down stairs for months or years; and did all in his power, by low tones and a mystic deportment, to prevent their knowing what he deemed to be the actual state of the patient, or what he prescribed. Yet, to some students, his compendious plan of medicine recommended itself very strongly; its simplicity was en- chanting; it required no reflection, and to this day, in every province of England, the injudieious and habitual employment of drastic mediea- ments duly proclaims the durability of his narrow doctrine and erro- neous example. We ought, perhaps, to regard as a branch or a continua- tion of Dr. Hamilton’s practice, the administration, by empiries, in such large and destructive doses of cathartic pills, which have been named to catch popular favour, or after their venders. Immediately after having taken his degree, Dr. Armstrong settled in Bishopwearmouth, a parish adjoining Sunderland. Among his first patients was the father of an intimate friend of his own in Edinburgh. This gentleman had laboured for nearly ten years under what was consi- dered an anomalous attack of diarrhoea, which soon yielded, however, toa mild course of laxatives ; and thus evinced the correctness of the young physician’s opinion of the disease being the result of overloaded bowels, and an effort of nature to throw off the offending cause. The case served to illustrate not only Dr. Hamilton’s practice, but, also, by a casual coincidence, to show the man himself in an advantageous point of view. ‘This gentleman happened to pass through Sunderland in a day or two after Dr. Armstrong had been consulted ; and when he was called upon by his former pupil, and earnestly solicited to see the patient, he firmly resisted the proposal, and gave as his reason that the practice recommended was undoubtedly correct, and that the issue of it would be fortunate. “It will gain you credit,’ he said, “but if I am con- sulted, the recovery will be attributed to my counsel and longer expe- rience, when all the merit in reality will be due to your own sagacity.”” Fis locc kon OF DR, ARMSTRONG. iH, pa He added; “take the advice of an old man, and avoid consultations in all cases where you feel satisfied that you understand the nature of a malady.’ The advice we believe to be sound and useful, both for the interest of the patient and of his medical attendant. The latter, accus- tomed to rely on himself, will summon his energies to the task before him, and pass in review, in his own mind, the best and most efficient measures. Whereas a habit of frequent consultation is apt to in- duce timidity and self-mistrust by the very fact of looking to another for assistance. The responsibility is indeed divided ; and very much on this account, will there be, we fear, diminished watchfulness of symptoms and energetic treatment for their removal. The successful issue of the case which has given origin to the above remarks, was favourable to Dr. Armstrong’s professional advancement. His grateful patient was in the habit of riding about town (Sunderland) on a pony, and sounding, at all times, the praises of his physician. The recommendations of this gentleman alone established him at once in a practice of about 200/. a year. In his twenty-eighth year, and when he had been only four years in practice, he was enabled to remove to a large house in Bishopwearmouth, which town he had left some time before for Sunderland, and to keep his carriage. In this same year, 1811, he was clected physician to the Sunderland Dispensary ; and he married the daughter of Charles Spearman, Esq. of Thornley, near Durham. So much more fortunate was Dr. Armstrong in his certain prospect of obtaining a competency than the celebrated Dr. Baillie, who did not enjoy it until after he was forty years of age. The activity of Dr. Armstrong’s mind prompted him, although little loaded with medical learning, to become an author. THe was a diligent observer of disease, and his observations appeared to himself to be both original and valuable. His papers in the ninth volume of the Edin- burgh Medical and Surgical Journal on Brain Fever from Intoxica- tion, and on Diseased Cervical Vertebra, are characteristic of his powers of minute description, and of his love of detail ; peculiarities which were equally observable in his conversation. ‘They also exhibit him in the light of a careful and reflecting practitioner. His language, even in these his first compositions, is fluent and correct; but there is, x LIFE AND WRITINGS as usually happens with unlettered men, a tinge of affectation observable in his various and not always very important references, including one to Paley’s Natural Theology, to warrant the somewhat vague and su- perfluous announcement, “ that the great energies of nature are known to us only by their effects.”* About the end of the year in which these papers appeared, (1813) Dr. Armstrong published his work on Puerperal Fever, for which he always retained an author’s partiality—probably from the agreeable as- sociations connected with it. This work first brought his name into public notice, and procured for him the approbation of his professional brethren. Of its distinctive merits we shall speak hereafter, when passing in review the professional character and writings of its author. In the following year, he communicated a paper to the Edinburgh Journal on a case of « Cynanche Laryngea successfully treated’? in a girl ten years of age; and also one containing “ «2dditional facts and observations relative to the Puerperal Fever,” in which he notices some communications made to him on the subject in consequence of the publication of his work. In 1815, continues Dr. Boott, the last contribution which he made to that valuable Journal appeared in an essay containing “ Brief hints re- lative to the improvement of the pathology and treatment of those chronic diseases usually termed nervous,” which he thinks are gene- rally secondary affections, inseparably connected with disordered circu- lation; and that if fixed principles as to their treatment are ever to be obtained, it must be accomplished by extending our views beyond the nervous system to other textures; for that it will be found on examina- tion they depend upon venous congestion or inflammation, and their consequences, or upon some disorder of function or structure in the viscera of the three great cavities ; an idea which has since been fully verified in many cases by the researches of late pathologists. Dr. Boott might have added, that the merit of originality in these views, espe- cially of the dependence of nervous disorder upon derangement of the circulation, belongs of right to Dr. Parry, who promulgated this patho- * British and Foreign Medical Review, January 1836, p. 38-9. OF DR. ARMSTRONG. xi logy in the Memoirs of the Medical Society of London, some thirty years before Dr. Armstrong’s publication. ‘The favourable reception which his treatise on Puerperal Fever met with, encouraged him to extend his views farther; and in 1816 his cele- brated work on Typhus appeared,—which “at once raised him to a very high eminence in his profession. It passed through three large editions in three years, and was received almost with acclamation by the medical public, not only in this country, but throughout America, where it obiained for him, from some of the most eminent professional men, the name of ‘ the modern Sydenham.’ «Jt was characterised as a work abounding in judicious reflections, refined distinctions, and practical illustrations of the highest import- ance.” Dr. Armstrong’s success, as an author, now impelled him to try a more extended ficld of practice, and, accordingly, he determined to re- move to London. In October 1817, he resigned his situation as physi- cian to the Sunderland Dispensary ; and in February 1818, after placing his wife and his two children in lodgings at Durham, he repaired to London, with no other recommendation than that which his works and reputation afforded him. The expenses attending a physician’s life had not enabled him to save means sufficient for the support of his family in so expensive a place as the metropolis, before his name should have become known there. His first feelings in his new position are thus described by Dr. Boott : “He took lodgings at No. 38, Great James street, Bedford row, where he resided several months alone. This was the most trying period of his life. All those domestic sympathies upon which he so much depended for happiness were far removed from him, and he felt as it were alone in the world, anxious about his present and uncertain of his future fortunes. He never, to the close of his life, courted genc- ral society, and had few inducements to mix in public amusements; for his tastes centered in his professional pursuits, and his enjoyments in the bosom of his family, and in the familiar society of a few personal friends, His sensibilities were acute,and his mind simple and discern- ing in its instincts and desires. He had left a society to which he was xii LIFE AND WRITINGS attached by the ties of gratitude; and in the oppressive solitude of his present situation he keenly felt the loss of his early friends, and became fully sensible of the hazard to which he had exposed the interests of his family. He has often told me that the loneliness of his situation at times overpowered him; and that so oppressive was the busy scene around him, in which he stood a stranger, uncared for and unknown, that he sometimes found relief in tears, and tried to drown the con- sciousness of sorrow, by seeking sleep in his darkened chamber at noon.”” The larger the city, and