Volume 1

Text-book of the principles and practice of medicine / by the late Charles Hilton Fagge and Philip Henry Pye-Smith.

  • Fagge, Charles Hilton, 1838-1883.
Date:
1891
Catalogue details

Licence: Public Domain Mark

Credit: Text-book of the principles and practice of medicine / by the late Charles Hilton Fagge and Philip Henry Pye-Smith. Source: Wellcome Collection.

    25/1212 (page 3)
    abstract, but with separate diseases, with pains and discomforts, the cause, seat, and origin of which the physician seeks to detect, and, if possible, to cure in each case—luTptvn yap k-a^' tKuaTa. Nosology.—Since diseases are of diverse nature, so that they are not mutually comparable, it is clear that a scientific classification of them is impossible. Hence there is little left of the importance formerly attached to Nosology, or the right nomenclature, definition, and arrangement of diseases. It may, however, still be asked—and the inquiry is not without a practical bearing—whether in naming and classifying diseases we should do so according to their causes, their character as physiological luvccsses, the structural changes they produce, or the sijm2)toms by which we recognise them during life. The first is the most satisfactory basis, for it is fundamental. When we define scabies as the eft'ects of the presence of an acarus in the skin, or drojit wrist as paralysis from lead, we know the most important points at once, the leading indications for prevention and for cure. But our knowledge is far too imperfect to render an {etiological classification possible. A pathological arrangement is almost as hopeless, for in many cases we are ignorant of the physiological derangements which are taking place, and the long list of infiammations includes very diverse diseases. What has in modern times been called a pathological nosology is not one of processes, but of residts. It is really based, not on morbid physiology, but on morbid anatomy. During the present century the utmost zeal has been devoted to the search for organic lesions in the dead body, and to tracing the relations between such changes after death and states of ill- health during life. Many anatomical lesions have been thus discovered, which were unknown to the physicians of former ages ; and many of these can be recognised without difficulty by skilled observers, though the patient is unaware of their existence. On the other hand, there is a not inconsiderable number of disorders which force themselves into notice by the pain or discomfort they occasion, and which may in some cases destroy life ; and yet after death all the organs and tissues seem to have their structure unaltered even when they are examined with the highest powers of the microscope and by every chemical test that can be devised.* At first sight it appears as though there were a fundamental distinction * By many writers, tlu' occurrence of functional diseases is altogether ilenieiL Tlicy believe that if our inquiries could he carried far enough we should discover some morliid changes to account for every disorder or complaint, even the slightest. 'I'hey say that they cannot conceive how any of the vital processes should fail to he carried on naturally so long as every part of the body retains an absolutely normal structure; and they seem to su]i]iose that 110 further argument is needed to establish their opinion. But, as is well known, the history of philosophy is full of lessons which show how fallacious it is to assume that things are impossible because when submitted to the scrutiny of our faculties they seem to be inconceivable. The question is not whether an effect can arise without a cause, but whether the cause must necessarily be of one particular kind because we know of no other. However, physiology suggests an analogy that may not perhaps lie without its aiiplication to patholngy ; the case of muscular fatigue. This was formerly supposed to be the result of the consumption of contractile tissue in the performance of work. It is now known to be due to the aceuniulatioii in the tissues of those waste products which arise out of the contractile material so consumed. But the nerves and nerve-centres are also liable to exhaustion; and it seems not unlikely that the neuroses—as functinnal nerve disorders are called—may depend upon similar conditions.—0. H. F.