Manual Of Clinical Medicine And Physical Diagnosis 1869 It consists solely of inflammation, which. Ion" after it had been numbered among the curiosities of medical experience, has in some mysterious way been adopted by our author. The fact may be accounted for in some measure perhaps by the circumstances under which he observed the insane. He met with them associated together in large numbers, in establishments very like general hospitals in their construction and service, all of them victims of disease, and consequently subjects of medical treatment. Once a day perhaps he passed through the wards, his attention being given to those chiefly who seemed to require medication, and when the requisite amount of blood had been drawn, and a quantum sufficent of pills and powders and draughts were ordered, his work was done. Practically the mental condition was almost entirely ignored. What is called moral treatment, and which now is regarded as of paramount importance, was quite beyond the sphere of his duty. Even had he recognized the importance of those appliances that are made directly to the mind, he could have used them only on the most limited scale. In a large, crowded establishment in the midst of a populous city, with no land except some dreary courts in which a few half animated beings exposed themselves to the sunshine, there could be used none of those means for exciting a healthy mental activity which constitute the honor and glory of modern asylums for the insane. And thus it is that in this whole book not one word is said about the things pertaining to moral treatment. Had the author been the resident physician of an establishment in the country, mingling freely with his patients, learning their history, following the course of their malady from day to day, and watching the healthful influences of surrounding nature, we should have heard much less of cupping and tartar emetic, and something of employment, labour, amusement, and mental occupations.
For many of the imperfections of the present work, the author should not be held to a very strict account. It was left by him in manuscript when he died in 1802, and translated by some pious pupils from the Dutch into German, and thence into English. We gather this much from the preface, which, however, is so blindly written that we hardly know what to make of it. The English translator may have rendered the sense of the author, but beyond this he can be allowed no claim whatever to merit. His language is often as destitute of idiomatic expression as the first exercise of a schoolboy in construing his Livy or Virgil. The following sentences are specimens of a multitude of others: ‘This occurs in a still higher degree with constipated bowels and so-called obstruction, at the ground of which, as I shall afterwards show, strictures of the large intestines lie.’ Such a patient will, according to his disposition, seek to explain the manner in various ways, but he mostly runs into attacks on his emotional life and self-reproaches. The phrases and turns of expression which have become familiar to the English medical reader are singularly ignored by the translator. Thus, throughout the whole book, without a single exception, the word section is awkwardly used in place of autopsy. All this shows, what many people forget, that to translate from one language into another something more is required than a competent knowledge of the original. Unless by means of some practice in writing one has gained a certain command of language, enabling him to recast the thought in his own vernacular, his work will be but a poor performance.
Art. XXXVI .—A Manual of Clinical Medicine and Physical Diagnosis. By Thomas Hawks Tanner, M.D., F.L.S., etc. Third American, from the second English edition. Revised and enlarged by TILBURY Fox, M.D., Lond., Physician to the Skin Department in University College Hospital. 12mo. pp. 360. Philadelphia: Henry C. Lea, 1870.
Dr. Tanner is a skilful and industrious compiler, and a good practical observer; and, of all his works, this has best met its purpose of usefulness. By avoiding the domain of therapeutics, and, mostly, that of pathology, he has been able to give a systematic view of the methods, as well as the field, of medical observation, in small compass, and of great value to the student. The revisal and enlargement of the second English edition, by Dr. Tilbury Fox, have been accomplished fully upon a level with the character of the original work.
Such a book is of service during a course of medical study, in two ways. One is, the aid given at the bedside, in the dispensary, or in autopsy examination, to the actual exploration of disease and its results. The other, is an increase of the student’s acquaintance with those salient ideas, whether of positive fact or of current theory, which constitute almost the alphabet of medical science, and with which every physician should be familiar. As the first edition was published in 1855, it is of some interest to notice what have been the principal additions made necessary by the progress of clinical medicine since that time. As such, we may enumerate laryngoscopy and rhinoscopy, the use of the hypodermic syringe, extension of the applications of the ophthalmoscope in diagnosis, improvements in the use of chloroform by inhalation, notice of the influence of dampness in producing phthisis, the definite use of the thermometer in diagnosis and prognosis, the sphygmogmph, embolism as a cause of cerebral disease, cerebro-spinal meningitis, and locomotor ataxy. Aphasia, very singularly, is not named at all in the book. The most important contributions of Dr. Fox to this edition are more than thirty pages of new matter concerning the diagnosis of abdominal and cerebral affections, and a considerable modification of the chapter on Skin Diseases; besides minor but important additions, above mentioned. We find, also, extension of the instructions concerning the English law in regard to insane patients, and of that upon the subjects of life insurance, medical evidence in cases of shock from railway accidents, compulsory vaccination, and feigned diseases. There is considerable extension of the section upon Medical Anatomy; and the diagnosis of exophthalmic goitre, or Graves’ disease, is briefly mentioned, having been omitted from the previous edition. We are glad to see credit given to Dr. Bowditch, “of America,” for his share (with Dr. Buchanan) in the inquiry into the relation between dampness of soil and the prevalence of consumption; although it would have been in place also to allude to the importance, amply shown by MacCorrach, Parkes, and others, of foulness of atmosphere in the same causation.
In the chapter on the Diagnosis of Skin Diseases, while a considerable amount of valuable information has been added by Dr. Tilbury Fox, with whom the subject has been one of special study, we are unable to see that the classification has been much, if at all, improved. Is there, for instance, good reason for calling lepra a diathetic disease, while eczema is regarded as only a local inflammation? Yet more doubtful seem the subordination of impetigo as merely an incidental stage or variety of eczema, and the designation of herpes as one of the “neurotic” affections. In fact, the genius of Willan laid so good a foundation for dermatological classification, that those who have followed him have done, in most cases, the best service when they have, without abandoning his plan, simply added or made emendations in accordance with the progress of knowledge.
The chapters on Entozoa, and on the Chemical and Microscopic Examination of the Blood. Urine, etc., have been well brought up, by Dr. Fox, to the present state of science: although (as a minor point) a sufficiently definite account is not given of the determination of the presence, under some circumstances, of spermatozoa, and of their importance in regard to questions of impotence, rape, etc. A well-placed addition in this last chapter is, a precise description of the methods of quantitative analysis of urea (after Liebig) and diabetic sugar (after Fehling). On the whole, there are very few books, of less than 400 pages, containing so much information of value to the student, as this.
H. II.
Key Takeaways
- Early medical observations were heavily focused on physical symptoms and treatments like bloodletting and medication.
- The importance of mental health treatment was largely ignored in the context of institutional care for the insane.
- Advancements such as laryngoscopy, hypodermic syringes, and improved diagnostic tools have significantly impacted medical practice.
Practical Tips
- Understand historical practices to appreciate modern advancements in clinical medicine.
- Recognize the limitations of past treatments when evaluating current medical protocols.
- Study the evolution of medical knowledge for a comprehensive understanding of disease diagnosis and treatment.
Warnings & Risks
- Ignoring mental health can lead to inadequate care for patients with psychological conditions.
- Over-reliance on outdated practices may hinder effective patient management in emergency situations.
Modern Application
While the historical context provides valuable insights into early medical practices, modern survival preparedness benefits from understanding these limitations and advancements. The knowledge of how far medicine has come is crucial for appreciating current standards and technologies.
Frequently Asked Questions
Q: What were some key diagnostic tools introduced since the first edition in 1855?
Key diagnostic tools introduced include laryngoscopy, rhinoscopy, hypodermic syringes, ophthalmoscopes for diagnosis, and improvements in using chloroform by inhalation.
Q: Why is the classification of skin diseases debated?
The debate centers around whether conditions like lepra should be classified as diathetic diseases or if they are merely local inflammations such as eczema. The subordination of impetigo and herpes also raises questions about their true nature.
Q: What advancements were made in the examination of bodily fluids?
Important Note
Advancements include precise methods for quantitative analysis of urea after Liebig and diabetic sugar after Fehling, enhancing diagnostic capabilities.