Galen : a bibliographical demonstration in the Library of the Faculty of Physicians and Surgeons of Glasgow, December 9th, 1891 / [James Finlayson].

Date:
[1892]
Catalogue details

Licence: Public Domain Mark

Credit: Galen : a bibliographical demonstration in the Library of the Faculty of Physicians and Surgeons of Glasgow, December 9th, 1891 / [James Finlayson]. 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.

    13/16 page 13
    A better insiglit into Galen's really scientifit; methods of diagnosis may be gained from his treatise De Loch Affect is; indeed, in several passages, one might almost think lie was reading a modern treatise on medical diagnosis. I have selected the following extract from this treatise as to the diagnosis of urinary disorders. It is rendered from Darem- berg's French translation (tome ii, p. 471). [Differential Diagnosis in Urinary Disorders ]-Another kind of dia- gnostic is drawn from certain signs which manifest themselves when something abnormal is enclosed in a region with which it has no natural relation—for example, a stone in the kidneys or bladder, or pus in the thorax. To this variety may be referred a clot of blood, whatever may be the place wliere it is enclosed, or any peccant liuraour engendered in the body of the animal, or introduced from without. Tliis fact has raised among many modern physicians a question, useless indeed for practical pui-poses in medicine, but giving rise to speculative views. They have asked themselves if such abnormal things, engendered in us, come under the category of allected places ; or if, no place being affected, the ani- mal suffers solely from the presence of this unnatural cause. That such a problem is useless, as I have said, is easily recognised in considering how much diagnosis contributes to practice. Thus, suppose there is a person who has for three days passed absolutely no urine, would we not immediately inquire in which part of the body the cause of mischief is ? Is it in the kidneys, in the ureters, in the bladder, or in the urethra ? Cer- tainly we would not search in the liver, the lung, tlie spleen, the stomach, the heart, nor in any other part, because not one of these is a urinary organ; but if we did not know tliat the secretion of urine takes place first of all in the kidneys, then that the urine passes through the ureters to the bladder, and that it is evacuated from it in the manner that we have indicated in the discussions. On the Natural Faculties (l, viii), we could not discover anything from this. It is not even enough to go this length, for it is preferable to search, among the causes announced, for what may be the cause of the retention of urine. Hei'e is the method to follow in this inquiry : to inquire into all the symptoms present and past, examining for one's self the sym- ptoms actually present, and ascertaining the past symptoms, not merely from the patient but also from the attendants (see Hippo- crates, Aphor., 1, i). Is there, for example, a tumour in the region called pubic—a, tumour indicating cleai-ly that the bladder is full to a certain extent, and that the discharge of urine is completely suppressed; is it not evident either that the force which presses the urine out is abolished, or that the passage of the urine is obstructed ? But one will examine next if this force can be abolished, recollecting how the evacua- tion of urine is effected in healthy persons, who possess voluntary con- trol, the muscle which surrounds the neck of the bladder ceasing to act, while the bladder itself acts. The action of the muscle depends on our will, that of the bladder is involuntary and physical. In fact we have shown in our commentaries On the Natural Faculties, that in almost all parts of the body there exists a faculty for separating superfluities, a faculty which all animals constantly possess, and of which they make use when hampered by these superfluities. When then this faculty has been injured, there results sometimes the affection named ischuria. But if you placed the patient in such a position that the neck of the bladder inclines downwards, pressing with your hands on the abnormal tumour, the urine will be e.xpelled. If this attempt leads to no result, the idea of paralysis must be abandoned, and we must suppose that the urethra is obstructed. In fact, the paralysis of the muscle which surrounds the urethra produces not ischuria but involuntary discharge of urine. [Kiihn, vol. viii, p. 7.] [Galen then goes on to describe, in similar detail, what kinds of obstruction in the urethra might cause retention of urine. He supposes the case of a child who had symptoms of stone previously ; such a case is to be farther explored by a catheter,
    digitised image 1
    digitised image 2
    digitised image 3