<Callout type="warning" title="Limited Moral Treatment">The author's work largely ignored moral treatment, focusing instead on physical methods like bloodletting.</Callout> <Callout type="important" title="Daily Rounds">Doctors made daily rounds to assess patients but primarily focused on physical ailments rather than mental health.</Callout> 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 lie 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,” p. 55. 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. 365. 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 strangely, 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 MacCorraac, 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.
Key Takeaways
- The early 19th-century medical approach focused on physical treatments like bloodletting rather than mental health.
- Daily rounds were conducted, but they primarily addressed physical ailments over mental conditions.
- Modern readers should recognize the limitations of historical practices and focus on evidence-based medicine.
Practical Tips
- Modern practitioners can learn from this chapter by understanding the evolution of medical ethics and patient care.
- It is important to balance physical treatments with psychological support in modern healthcare settings.
- Historical texts like these provide context for current medical practices, highlighting areas where progress has been made.
Warnings & Risks
Limited Mental Health Care
The chapter highlights the lack of focus on mental health care in early 19th-century asylums.
Be aware that the language and terminology used in this text may be outdated or offensive to modern readers. The chapter emphasizes the overuse of physical treatments like bloodletting, which can be dangerous if applied without proper medical knowledge.
Modern Application
While the historical techniques described in this chapter are outdated and potentially harmful, they provide valuable context for understanding the evolution of medical practices. Modern readers should focus on evidence-based medicine and prioritize both physical and mental health care.
Frequently Asked Questions
Q: What were the main limitations of the medical approach described in this chapter?
The main limitations included a lack of focus on mental health, reliance on outdated physical treatments like bloodletting, and poor language translation from the original Dutch text.
Q: How does modern medicine differ from the practices described in this chapter?
Modern medicine emphasizes evidence-based treatment, psychological support, and ethical considerations. It has moved away from harmful practices like bloodletting and focuses on holistic patient care.
Q: Why is it important to study historical medical texts like this one?
Studying these texts provides context for the evolution of medicine, highlights areas where progress has been made, and helps us understand the limitations of past practices. This knowledge can inform current medical ethics and patient care.