Licence: Public Domain Mark
Credit: Lectures on the theory and practice of physic (Volume 1). Source: Wellcome Collection.
Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)
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![NEGLECT OF MORBID ANATOMY. on very well. Some morning or other, on coming to the hospital, you are astonished to see the change which has been wrought in him since the day before ; his countenance is altered, his pulse can hardly be felt, and life is fast ebbing away. You ask the nurse about him, and she tells you that, during the night, he suddenly complained of violent pain in his belly. On examining him, you find distinct evi- dence of intense peritonitis, and, after death, dissection reveals the existence of a perforating ulcer of the intestines, of which there was apparently no sign during life, except fever and the unexpected oc- currence of peritonitis. The frequency of the complication of local disease with fever, its insidious latency, and the fact, that death, in the majority of fever cases, is caused by visceral inflammations, all clearly point out the necessity of being intimately acquainted with every modification of local disease before you proceed to the study of fevers. Diseases of the Digestive System. — I commence with the digestive system. I am anxious to do this for several reasons, but for none more than this — that, to the improvements made in the pathology of the digestive system we owe much of the rapid advance- ment of modern practical medicine. Before our time the pathology of the digestive system was very little known, and if not quite a terra incognita in medicine, there existed respecting it a great deal of misconception. The schools were deeply tinctured with the doc- trines of the Humoralists and the Brownists ; and this had the effect of giving rise to irrational theories and false notions of the true state of the system in disease. The humoral pathologists, who sought for disease in an alteration of the fluids alone, neglected the study of visceral lesions; and when they turned their attention to the diges- tive system, they only considered it, its secretions, and not its actual condition, or the state of its sympathies. The liver, with them, was an organ of the highest importance, and the secretion of bile claimed a vast share of their attention. To it they gave a paramount influence, and to an alteration in its quantity and quality they attributed most of the changes which occur, not only in the digestive tube, but also in the whole system ; and hence the great object of their practice was to attempt to restore its healthy condition, convinced that if this were once accomplished every thing would go on favourably. From this, too, arose the purgative plan of treatment in various forms of intestinal disease, a plan too often rashly pursued, even where there was unequivocal proof of inflammation in the digestive tube.* Their sole purpose was to evacuate sordes, to produce a flow of healthy bile, and to eliminate depraved secretions : and they did this without possessing any knowledge of local inflammation, or of the effects of disease of the digestive system on other organs. The followers oi Brown, on the other hand, only admitted disease of the digestive system in a state of intense, manifest violence, as, for instance, ileus or violent enteritis ; but in the great majority of cases, they did not recognise intestinal inflammations, because their prominent symptom * [Our medical brethren of the south and west will see, if not re- prool,at least a salutary hint, in these remarks of the lecturer. — B.] 3*](https://iiif.wellcomecollection.org/image/b21156955_0039.jp2/full/800%2C/0/default.jpg)
