Hunterian reminiscences; being the substance of a course of lectures on the principles and practice of surgery, delivered by ... J. Hunter, in the year 1785 / taken in short-hand, and afterwards fairly transcribed by ... James Parkinson ... Edited by his son, J.W.K. Parkinson ..., by whom are appended illustrative notes.

Date:: 1833

Credit: Hunterian reminiscences; being the substance of a course of lectures on the principles and practice of surgery, delivered by ... J. Hunter, in the year 1785 / taken in short-hand, and afterwards fairly transcribed by ... James Parkinson ... Edited by his son, J.W.K. Parkinson ..., by whom are appended illustrative notes. 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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N tion of the cellular tissue, it is generally formed near’ to the surface of the body. If in this stage corrective and invigorative means should be employed, with attention to preserve an equable temperature of the body, this may be removed ; but if these means are neglected, increased action comes on, and slowly advances to imperfect suppuration. The pus, which is as badly constituted as the blood from which it is formed, is slowly brought to the surface and discharged by ulceration, which admits of very tardy reparation, there being now too little action. This may be considered as a tolerably correct picture of the scrofulous abscess and ulcer. Let us now suppose this wrong action to go on for a considerable time, but in some internal part of the body, where the temperature is more equable, being productive of the same deposition of unhealthy matter which the absorbents refuse to remove, except, indeed, the more fluid part, and the surrounding parts appearing undis- turbed by its presence: thus tubercles may be said to be formed*. These continue for a longer or shorter time, either stationary or gradually increasing, when one of three changes may take place in them,—either the constitution and formative action of the blood may be so improved, and the system so invigorated, that no more such matter is secreted, and what has been deposited may be taken up by the absorbents; or the surrounding parts may become sensible of them, as they would of extraneous bodies, and set about removing them by suppuration and ulceration; or this unkindly matter may, perhaps, prove the nidus for the growth of hyda- tids, the rudiments of which may have been deposited wiih it, which, as they enlarge, may destroy all trace of the tubercle in which they were formed. Scirrhous and other tumours may be adduced as additional instances of the effects of wrong actions; and when a hollow glandular apparatus called a follicle, or the bulb of a hair, becomes the seat of these wrong actions, then we may have formed what is termed an encysted tumour. Morbid changes of countenance.—P. 41. Notwithstanding that our diagnosis and prognosis of disease should be drawn from collective rather than from individual symptoms, however strongly marked, or however alarming or encouraging they may appear separately, yet there is one symptom which, even, if taken singly, is a very certain guide to the experienced eye ; namely, the change which the countenance undergoes in different diseases, and in the different stages of the same disease. A knowledge of this can only be acquired by experience ; no language can impart it to another ; therefore it ought to be the business of the medical student to put himself, as early as possible, in possession of this desirable talent, by carefully watching and noting in his mind the different expressions of the countenance under disease. A portrait painter could not be more usefully employed than in delineating, in the wards of an hospital, the features of the countenance under diseases in which a strongly marked difference exists: thus we might have expressed, on canvas, in addition to the facies Hippocratica, a facies rheumatica, tetanica, hydrophobica, syphilitica-]-, and those expressive of the different inflammatory and congestive affec- tions of the respiratory organs, and of the different types and stages of febrile diseases. Morbid variations of the pulse.—P. 41. Although, upon the principle of the arteries acting by elasticity alone, it may appear, at first sight, difficult to account for the morbid variations of the pulse, yet this difficulty may be much removed when we consider that the chief deviations of the pulse from a healthy state depend either upon the action of the heart alone, or upon it, combined with the degree of resistance that is offered in the capillaries. And, again, we must agree with the late Dr. Parry, that this elasticity of the arteries is modified by life, and consequently influenced by * The notion that the want of power in the heart has a great share in the production of the scrofulous abscess and tubercle, is greatly strengthened by the following observation, extracted from the Inaugural Dissertation of Dr. Robert Dickson on Pthisis Pulmonalis, who says, on the authority of Portal and Lieutaud, when on the subject of the post-mortem appearances, “ Cor ssepe mollitur, interdum minuitur, sed haud infrequenter, prsesertim latere dextro, dilatatur: arteria pulmonalis quoque saspe dilatatur. Cor aliquando adipe obrutum est.” t The Annotator has frequently heard the venerable, father of British surgery, Sir William Blizard, determine the nature of a disease to be syphilitic, merely from the expression of the countenance, before he had the opportunity of judging from any other symptom.

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