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his diagnoses, have raised him to a high position among his fellow practitioners. It is said by those who do not so highly esteem him, that he tries to reduce every thing to too much of a mathematical standard ; that he endeavors to arrange all his comparisons of diseases in too tabular a form; that, for the sake of this arrangement, he often compares many maladies together, as regards the distinction, between which there is no great danger of confusion; thus, by pointing out imaginary dangers, inducing exactly what he wishes to avoid, by making the student too prone to guard against what he considers a synonymous malady, when, if he had not seen this comparative arrangement, the connection between them would never have occurred to his mind.
But, for myself, I think that the style of the work has, in many points, a decided superiority to the majority of the works which I have seen on the practice of medicine; and I think the plan which he has written out, and which is the same that he is accustomed to follow before his class, in practice supplies what is a lamentable deficiency in the lectures delivered at our medical colleges and at the cliniques at the hospitals.
This short-hand, tabular arrangement, like the two and two make four of the multiplication table, has the advantage of bringing directly before the eye what the affections are that are the oftenest confounded, and what are their distinctions; impresses them much more forcibly upon the mind, tham if a lengthy account be given of all the signs, whether as means of warning, or described as the symptoms of the disease alone upon which the treatise is written.
I do not assert that he is the only person who has compared diseases in the same manner; nor that he is the first person who has established good comparisons; but merely that it is more extensively carried out by him,—that the same system of comparison is not limited to a few of the most important affections, but is extended in an equally thorough manner to all, no matter how innocuous they may be in their results. If there is any disease which, in its prodromes or subsequent symptoms, is likely to be confounded with another, each, under its respective heading, has been most carefully and ably compared; and any synonism which might lead to an error in the diagnostic, has had the essential differences in the plainest manner made manifest.
It may seem somewhat Hibernian, to assert that it is easier to declare what a thing is than what it is not,--that it is more feasible to say that any disease which we may have under hand bears such a specified name, perusal
prove that it is not one of others which in some peculiarities have a resemblance. Yet I think it is so: we have a class of symptoms laid down for us as the characteristics of a disease, and we are told that, with slight variations, these are our guide-posts; another malady of a somewhat similar nature, but for which a different treatment is needed, and from which a different result is to be expected, shows nearly the same symptoms; we hesitate between the two, from the fact that they may present some anonialies; we are not able to commence with the whole class of diseases showing nearly the same order and character of signs, and compare the one with the other, and so by this gradual comparison and exclusion, to sift the number down to what we may feel sure is the disease in question.
The medical student receives his account of diseases from the of books, or from the mouth of his instructor, as plainly mapped out as are the party-colored divisions of the earth's surface on a school atlas. It seems to him as if there is a well-established series of disorders, and that, except in rare cases, each lies so distinctly plain from the other that no confusion could possibly arise. He hears his professor commencing with an affection of the head or chest, give the name and means of its diagnosis, which is followed up by the usual description of the routine of treatment, the complications; the difficulty of distinguishing this from any other, being carefully kept from him in order to do away with any confusion in his mind at that time, and also because the limits of a lecture or hospital visit do not allow this comparison, which necessarily would demand for each disease a recapitulation of all the symptoms or results which had been described before, or which are to be given at some subsequent time.
The same remark applies to what is said at the hospital bedside. He hears a disease named, he is told that its characteristics are such and such symptoms, but he is not warned against another which in many respects may be its counterpart. All seems to him plain sailing, and he wonders how there could ever have been any doubt in his mind as to what the malady in question might have been. But, is he guarded against an error in the next case, which, perhaps, may be a deviation from the preceding? Does it not induce a habit of jumping at too hasty conclusions, and of too positive assertion ? Will he not, as a practitioner, often taking too little care in the diagnosis, burthen a disease with a name, and console himself with the reflection, that because it is christened as legitimate, there can be no danger of a bastard substitute ? The
boldest navigator is he who is the most ignorant of the existence of rocks and shoals; he may be, for a time, as fortunate as the old gray-beard, who is constantly suspicious of danger and on the guard against accident, but still, he is liable at all times to destruction from the hidden dangers to which he is exposed.
There is no doubt that with many, in the world at large, this decided, quick method of naming a disease, has its effect. That man will be supposed to have the most thorough professional knowledge who, after a few questions and a quick examination, affirms that he has to treat any one of the diseases to which names have been given. It is supposed, at once, that there is more skill in this scintillating declaration than when they see each symptom weighed, and every possible source of error, which is called indecision, carefully investigated. Society is dazzled by its brilliancy, in the same manner as our eyes are more affected by the sudden, blinding flash of lightning, than by the deep, powerful glow of a conflagration.
This method of laying out, in a tabular form, the whole class of maladies having the same signs, and comparing the one with the other, is exclusively with M. Valleix, at Paris; with few exceptions, and these are among a younger class of lecturers,-among those who have formed themselves by the same model as he has himself. But in Germany, this system is most universally common. At the cliniques delivered at the hospitals, a most extraordinary length of time is devoted, in each case, to the comparison of signs. Oppolzer, at Vienna, when visiting the wards with his class, never declares the name of the malady under observation until the whole series with which it is likely to be confounded, are described; that is, a large quantity of diseases of the same nature are detailed, and whether they be fevers, diseases of the brain, cutaneous, or any others; and then he, or one of those about him, by a careful comparison, makes the one in question as sure as is possible.
M. Valleix is essentially a German, and, I believe, has studied to a great extent in the German schools. At his cliniques, he endeavors, in the same manner as in his work, and as is done by the German professors, to impress upon the young student in what points confusion is likely to arise, and to warn, as plainly as possible, against those errors which the present method is but too prone to induce.
Fourth AVENUE, CORNER 20th St.
Epidemic Cholera, as it appeared at the Franklin Street Hospital, du
ring the summer of 1854. By CHARLES A. BUDD, M. D., one of the Physicians of that Institution.
I propose, in the following paper, to give the statistics of the Franklin Street Cholera Hospital, alluding briefly to the treatment which was pursued in that institution, and to the pathological appearances revealed by the autopsies. The first patient was received on June 25th; the last on August 31st. Whole number received, 606. Whole number died, 255; whole number discharged, cured, 351. Whites, 591; negroes, 15.
The epidemic was evidently at its height the last week of July, from which time, with but slight variations, it steadily declined. A large proportion of those who died, and on whom postmortem examinations were held, were found to have been suffering from some chronic organic disease, the organs principally involved being the liver and kidneys; the former presenting, to a great extent, evidences of fatty degeneration, the latter, a granular condition.
Among the females admitted, seven were pregnant, at periods varying from four to seven months. Three of these died, undelivered, and two of the seven recovered; they were all in a collapsed condition when admitted. In one of them, reaction was established previous to parturition; but having strenuously denied the fact of her pregnancy (being unmarried), and labor having set in, she immediately relapsed into a state of collapse, and died thirty-six hours after delivery. Many of the patients were suffering from either constitutional or primary syphilis, or from gonorrhæa; and several who were considered convalescent, had relapses and died, in consequence of having partaken freely of either fruit or spirits, stealthily conveyed to them by friends, and concealed about the bed.
The treatment recommended by Dr. Vanderveer, and fully indorsed by the other members of the medical staff, was the mercurial, in the fullest acceptation of the term; and, strange to say, not a single case in which ptyalism was produced, died. Hence, our energies were chiefly directed to procure this result; and, invariably, if indications of mercurialization were evident, during the progress of the disease itself, or during the consecutive fever, a favorable prognosis was given. It is true, that many recovered in whom salivation was not produced, still, calomel was administered in almost every instance, and in every stage. To those in whom stimuli were indicated, after the administration of a full mercurial, the following mixture was resorted to:
Of this, half a tablespoonful was given in a tablespoonful of brandy, according to circumstances. This appeared to exercise peculiarly happy, anti-emetic, stimulating properties, and was the only form in which opiates were administered, save where the consecutive fever assumed a dysenteric character; and then but rarely, as in a majority of the cases in which reaction was established, the tendency of the subsequent fever was