The principles and practice of medicine / by John Elliotson ; edited by Nathaniel Rogers and Alexander Cooper Lee.

Date:
1846
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Licence: Public Domain Mark

Credit: The principles and practice of medicine / by John Elliotson ; edited by Nathaniel Rogers and Alexander Cooper Lee. Source: Wellcome Collection.

Provider: This material has been provided by the Royal College of Physicians of Edinburgh. The original may be consulted at the Royal College of Physicians of Edinburgh.

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    How profound a judgment to reason upon these phenomena, and to investi- gate their causes;—to discern the analogies between affections which, at first sight, are perfectly distinct! And, at the same time, how cool should be the judgment duly to appreciate all fanciful analogies, all hypothetical suggestions ! Exactly the same difficulties surround Morbid Anatomy ; but in its case they are alleged, by some, as objections to its prosecution. But how could any affection beneath the surface of the body have been under- stood, without an ocular investigation of the parts affected ? How could pain in the chest, dyspnoea, cough, and pyrexia, have been known as signs of inflammation of the lungs or their membranes, unless the examination of persons who died under these symptoms, had proved such a lesion to he frequently their cause ? If knowledge can he thus obtained, why not obtain the utmost possible ? True it is, that incidental morbid appearances have often been mistaken as necessary and constant; and that some even pretty constant appearances have often been absurdly announced as the essence of the disease, when they were merely its effect, or (at the utmost) only among the number of its phenomena. Equally true it is, that changes after death have been mistaken for morbid appearances; as was pointed out by Dr. John Davy in the case of redness from imbibition of blood. a But such errors, surely, afford no reason for neglecting careful and extensive examina- tions of diseased parts, and drawing just inferences as to the connexion of the change of colour or structure with the disease;—they supply no reason for not cultivating so ample a field of knowledge scientifically. If a disease be accompanied by a change of structure or appearance within the body, surely this change, as a fact in the disease, is worthy of notice;—as worthy as visible changes in the skin, the mouth, or the eyes ; which changes are always carefully described by these objectors, even when merely secondary effects; though they differ from the facts of Morbid Anatomy, only in the accident of being cognisable ’without dissection; while they are not a wffiit more necessary to a perfect history of a disease, and are much less in number;—owing to the circumstance of nearly all our organs being con- cealed from view. After some diseases, indeed, no change of structure or appearance is discernible. But even here, extensive anatomical investiga- tion is important; for it often prevents us from forming groundless hypo- theses, as to the seat and nature of such affections. Hydrophobia might be referred to the stomach, were it not that the red patches, which are some- times seen in this organ after the disease, are frequently not to be detected. Tetanus might be thought always to arise from inflammation of the spinal maiTow, were not this part frequently found free from inflammation in tetanic patients. It discloses to us a fact which we might otherwise have doubted;—that diseases may be only functional, as well as structural;— that, in the vrords of one of the most intelligent and industrious cultivators of Pathology and Morbid Anatomy (Dr. Andral),—“ it is one of the most serious errors to which the ill-directed study of Morbid Anatomy can lead, to admit no other alteration in the economy, than those which are discover- able by the scalpel.”b We learn, in short, to form a just estimate of Morbid Anatomy;—that it is an important part of the basis, but by no means the “ main basis” of Pathology. Diagnosis of Diseases.—But if our art is to be perfected by a better ac- quaintance with the nature of diseases, it is not less to be perfected by im- a “ Transactions of the Medical and Chi- b “ Clinique Medicule ” ; Tome 3 ; Page rurgical Society of London Volume 10; 510. Page 89.
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