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Lectures on the Morbid Anatomy, Nature, and Treatment of Acute and Chronic Diseases; delivered in the Theatre of Anatomy, Webb-street, by the late JOHN ARMSTRONG, M.D. &c. Edited by JOSEPH RIX, M.R.C.S.-London, 1834. 8vo. pp. 851. AMONG the posts of honour which our profession offers to quicken the diligence of its most ardent votaries, there is no one which can vie in brilliancy with that of a popular lecturer. The applause which to others is doled out in scanty fragments, for whose complement they must appeal to the uncertain judgment of posterity, is meted out to him with an unsparing hand; and, even if he does not altogether escape unscathed by contemporaneous censure, he has but to enter his class-room" to read his glories in his pupils' eyes," and to hear the verdict of envy triumphantly cancelled by a boundless majority.
"Tunc dolor, et curæ, rugaque frontis abit."
In fact, the fame of which other men see but the reflected light through the long vistas of time and distance, is enjoyed by him face to face; so that for him the extravagant wish of the lovers in the old tragedy, that, for their sake, time and space might be annihilated, is almost literally fulfilled. This reward is great, but it is the reward of genius alone. He who hesitates in speech or in thought,-who reads his lectures, or compiles them,-who is too facile to have an opinion, or too obstinate to change one,-he who lacks the animation which brightens the features and enriches the voice of the discoverer and inventor, may be a trustworthy practitioner, but can never be a first-rate lecturer. The sparkling eye, the ever-varying tones, the pointed story addressed to the many, the sly allusion to the few, the original phraseology, the swelling period, the generous burst of enthusiasm,
-these constitute not the ornaments, but the very essence, of a course of lectures; without them, it becomes a mere book, with the unpleasing difference, that the price is measured by guineas instead of shillings.
The very pleasure with which we listen to the genuine lecturer arises in part from the instinctive consciousness that what we hear can never be read, since the most faithful report will be but a lifeless cast from the energies unfolded before us, and will indeed display but a very small part of them. No reasonable person, therefore, professes to be disappointed when he finds that a book can give, as the phrase goes, merely "the substance of lectures," and that the gorgeous colouring with which genius delights to invest its creations is gone for ever. In the present instance, however, the substance is so excellent, that we congratulate all our readers on the appearance of the volume before us: to the student it will be invaluable, and we know no one so advanced that he may not derive profit from the instructions of that master in the art, Dr. Armstrong. The chief merits of this system of physic consist in the minute plan for the examination of patients, the excellence of the diagnosis, and the simplicity of the treatment. This last indeed is carried so far, that to some it may seem to approach that undefined line which separates a merit from its kindred fault.
In the first lecture, when discussing the progress of medical science, Dr. Armstrong falls into mistakes which we should call very strange, if it were not that they are very common. After quoting Bacon, who says that up to his time but one man, Hippocrates, had studied physic the right way; and, after making the physician of Cos a standard by which to judge the merits even of Sydenham himself, we come to such errors as these:
"If we pass on from Egypt to Greece and Rome, where the cultivation of the fine arts was carried to the highest perfection, we shall find that but little progress was there made in the study of medicine; and it may be interesting to trace the causes which retarded the progress of this most important science.
"The first was ignorance: the ancients knew scarcely anything of anatomy and physiology. Their horror of dissection kept them in a state of profound ignorance of anatomy. Their physiology and pathology, for the same reason, were mere conjectures, and their conjectures were made without good foundation. Rather than wander in doubt, the human mind will always rest in error." (P. 2.)
So that Hippocrates, a few lines after being a standard of professional knowledge, becomes one of the makers of little
progress, one of the profoundly ignorant of anatomy! The plain truth is, that those who accuse the ancients of ignorance of anatomy shew their own perfect ignorance of the books which they are libelling. Who is there who, when reading Celsus, was not struck with the passage in which he gives the principles of those "qui rationalem medicinam profitentur?" After telling us that they judged the study of physiology necessary to the practice of physic, he goes on to say: "Præter hæc, cum in interioribus partibus et dolores et morborum varia genera nascantur, neminem putant his adhibere posse remedia, qui ipsas ignoret. Necessarium ergo esse incidere corpora mortuorum, eorumque viscera atque intestina scrutari; longeque optime fecisse Herophilum et Erasistratum, qui nocentes homines, a regibus ex carcere acceptos, vivos inciderint, considerarintque etiamnum spiritu remanente, ea, quæ natura ante clausisset, eorumque positum, calorem, figuram, magnitudinem, ordinem, duritiem, mollitiem, lævorem, contactum; processus deinde singulorum et recessus, et sive quid inseritur alteri, sive quid partem alterius in se recipit. Neque enim cum dolor intus incidit, scire quid doleat, eum, qui, qua parte quodque viscus intestinumve sit, non cognoverit: neque curari id, quod ægrum est, posse ab eo, qui, quid sit, ignoret. Et cum per vulnus alicujus viscera patefacta sunt, eum, qui sanæ cujusque colorem partis ignoret, nescire quid integrum, quid corruptum sit; ita ne succurrere quidem posse corruptis. Aptiusque extrinsecus imponi remedia, compertis interiorum et sedibus et figuris, cognitaque eorum magnitudine: similesque omnia, quæ posita sunt, rationes habere. Neque esse crudele, sicut plerique proponunt, hominum nocentium, et horum quoque paucorum suppliciis, remedia populis innocentibus seculorum omnium quæri."-Lib. i. cap. i.
Now, without defending the excessive zeal of these ancient dissectors, or lauding them for cutting their way to knowledge through living flesh, we must say, that it seems most flagrantly unjust to accuse them of lukewarmness in the cultivation of anatomy: it is as if Venus had been accused of being a prude. We hope, however, that the increasing study of the old writers among the rising generation will prevent even the most ordinary minds from being seduced by fancies like these, though they have led astray a Lawrence and an Armstrong.
We have already observed, that the preliminary part in which our author teaches the method of investigating disease is extremely good, and the following quotations will, we think, support our opinion. They are taken from the 7th
Lecture, in which Dr. Armstrong gives the indications of a sound and of a morbid condition of the sanguiferous system.
"Celsus makes an important observation with regard to the pulse, and one which every medical man should recollect, especially in visiting females. If a medical man, for example, at his first visit to a female, feel the pulse, he will often find that it will be 100, 120, 130, or even 160, with no other bad symptom. In these cases you should invariably follow the rule laid down by Celsus. The moment a medical man enters the room to visit a female she pants and heaves at the chest, and the pulse becomes very quick. But after a time the respiration becomes tranquil, and the pulse becomes natural.
"Celsus says you should always feel the pulse twice, when you enter the room, and again before you leave it.
If you judge from the first impression alone you will very often be deceived.
"And then certainly a long face has the effect of quickening the pulse; a solemn aspect often frightens women dreadfully, the heart pants and the pulse becomes quicker.
"The pulse may be quickened from organic disease affecting the heart, from tubercles in the lungs, or from extreme morbid sensibility of the nervous system.
"All persons who have extreme sensibility of the nervous system have a very rapid pulse. Women frequently complain of a pulse all over, at every part of the body. This depends upon the nervous system operating on the minute capillary vessels so as to produce an universal sensation of pulsation.
Copious abstraction of blood will quicken the pulse even of a person in health; and if you bleed a person in health to-day, tomorrow, the next day, and go on thus, you will produce fever, and on the fourth day the blood will be covered with a thick buffy crust, or, as it is called, the inflammatory coat.
"Again, general debility quickens the circulation very much; and this may often be perceived in weak convalescents.
"A convalescent patient lies in bed, and desires, day after day, that he may be allowed to get up. At one visit the medical practitioner finds the pulse, in the recumbent posture, as slow as 60, and allows the individual to get up, and at the next visit he finds him perhaps sitting up by the fire, with a pulse of 120, or even as high as 160.
When the pulse becomes thus quickened in the erect posture never allow a weak convalescent to sit up long; if you do, the heart partaking of the general weakness, and thus having the frequency of its action increased, the patient is sure to have a relapse
"The rule with regard to convalescents is this: if when a convalescent is sitting up, you find him with a slow pulse, he is safe; but if you find him with a pulse weak and quick, you must lay him
flat, and never allow him to sit up more than a quarter of an hour or half an hour for the first, second, third, or fourth time, so as to accustom him to it gradually.
"The pulse may be preternaturally slow.
"When you have known the natural frequency of the pulse of an individual to have been in health 70, and being called to visit him find the pulse as low as 50 or 60, and especially if it be labouring and irregular, you may suspect that there is some mischief either in the brain, the lungs, or the heart, and should investigate the case accordingly.
"You should ascertain first, whether the patient has been taking any medicine which may account for the slowness or irregularity of the pulse. I have been called several times to patients in whom the pulse has been reduced very much by the daily exhibition of digitalis, and has become very small. The same thing may occur from the continued use of antimonials.
"Sometimes it is from the exhibition of opium, the opium having gorged the brain with blood, which has produced this change in the heart's action." (P. 80.)
"The first kind of irregular pulse may be called:
"This is a kind of pulse which is very difficult to describe in words, although it is so peculiar I can readily recognise it. It gives one the idea as if the heart were struggling to throw off some superincumbent weight, or as if a weight were pressing upon a spring, which was reacting to endeavour to throw it off. This state of pulse frequently precedes apoplexy. It frequently depends upon congestion of the heart, the lungs, the brain, or the liver. It almost invariably happens that this oppression or obstruction is removed by bleeding, and it seems to indicate, as it were, the necessity for it.
"The pulse may also be,
"When it is perfectly regular, you have sixty or seventy strokes in a minute. But when it intermits, you may count the pulsations, say, one, two, three, four, and then you lose the fifth; there is an intermission of the pulse between perhaps the fourth and the sixth beats. In other cases the intermission is at the tenth, twelfth, or twentieth beat, so that in fact there is a loss of a stroke ever and
"This intermission of the pulse attends various conditions.
"I recollect that when I was a young physician this would have alarmed me exceedingly, for I thought it must depend upon organic disease. But now, if I were to observe an intermittent pulse, I should set about investigating the circumstances accompanying it. "It is extremely common to meet with it in weak convalescents, on sitting up, from the heart partaking of the general debility; and in these cases it is of no consequence provided you do not