« PředchozíPokračovat »
These places measured about one and a half by three and a half inches, as demonstrated by the patient's sensations, for they were entirely unaccompanied by any apparent organic change in the integument. For over a month the patient was treated for this pruritus, without avail, by internal medication and external applications, and it was always noticed that when the pruritus was somewhat better the diarrhæa was always worse, and vice versa. As she had for two years been under the best of treatment for this trouble before coming under my observation, and as the patient was very anxious to have something radical attempted, an operation was suggested, to which she eagerly consented. This was undertaken on the supposition that the disease was purely a neurosis, since the three common causes irritating discharge, skin diseases, and parasites - could be excluded ; also because the demarcation between the normal and hyperästhetic skin was so distinct.
On September 5, 1891, the patient was prepared for operation. The pruritic areas were first outlined by pencil, the parts having previously been shaved and treated antiseptically, and then the anæsthetic was given. She was in a much weakened and exhausted condition, and took ether badly. Elliptical incisions were made on the left side, around the hyperæsthetic skin, and the included integument dissected off, and the wound brought together by deep catgut sutures, reënforced by two or three deeper silk ones. On the completion of one side the patient was found to be acting so badly under the anæsthetic that operation on the other was postponed until another time. Recovery was uneventful; the wound healed perfectly without suppuration. She has never had any pruritus in the side operated on since September 5th, now more than eight months; and, what was quite unexpected, for three month she had none whatever on the right side either, so that that side has received no operation. Recently she has had slight itching at times on the right side. What was not unexpected, her diarrhæa practically ceased with her recovery from pruritus.
She writes (May 8, 1892) that she now considers herself a well woman.
The sanctity of the jury-room appears to be so well guarded that even in case of sudden sickness, a physician may not enter except after due process of law. In the Foss will case, tried recently in Boston, the jury were deliberating, when, late in the evening, one of them was 'suddenly attacked with what proved to be a stroke of apoplexy. The officer in charge notified the deputy sheriff, who, not having authority to let any one into the jury-room, drove across the city and informed the sheriff, but even this official was not high enough to act, and another expedition started in search of the judge. As the latter happend to be at home, the requisite order was obtained to summon a doctor. - Boston Medical and Surgical Journal.
EPOCHS IN MEDICINE.
BY JAMES C. WOOD, A. M., M. D., ANN ARBOR, MICH. [Being the Annual Presidential Address delivered before the Michigan Homeopathic
Medical Society, May 17, 1892.] If I were asked to name the discoveries or advances which, in my opinion, marked the four greatest epochs in the history of medicine I should, without hesitation, select the following: the discovery of the circulation of the blood, by Wm. Harvey; the discovery of vaccination, by Edward Jenner; the discovery of ether and chloroform; and the promulgation of the law similia similibus curantur, by Samuel Hahnemann. These several epochs have, I believe, more than all others, left their impress upon the development of medical science ; but each has been important in its own particular way. Thus, Harvey's discovery marked a new era in the study of physiology and anatomy; Jenner's pulled the sting from that plague of plagues - smallpox; ether and chloroform robbed the operating ampitheater of its former terrors, and the application of the law similia similibus curantur, judged even by those who are not its advocates, demonstrated the utter uselessness, and indeed the actual harmfulness of the practice then in vogue, if it did not, as you and I believe, give to the world the best and most universally applicable law of cure yet enunciated.
William Harvey, the discoverer of the circulation of the blood, was born in Folkestone, on April 1, 1578. His father, a prosperous Kentish yeoman, sent him through the Canterbury grammar school. At nineteen he took his B.A. degree from Caius College, Cambridge, and at twenty-four he was made a doctor of medicine by the University of Padua, where he had for instructors the renowned anatomists, Fabricius and Casserius. On his return to England, in 1602, he settled in London, and in 1609 he applied for the reversion of the post of physician to St. Bartholomew's Hospital. His application was signed by Dr. Atkins, the president of the college, and by James I. The occupant, Dr. Wilkinson, died the same year, and Harvey succeeded to the post. As a practitioner he became very popular, and had among his clientèle Francis Bacon and the Earl of Arundel. In 1628 he published his “Exercitatio Anatomica de Motu Cordis et Sanguinis."
I will briefly review the state of knowledge appertaining to the circulation of the blood previous to the publication of the foregoing work. According to the theory of Aristotle the blood in man and the higher animals is elaborated from the food in the liver. Passing from the liver to the heart, it is carried by the veins throughout the body. His Alexandrian successors,
Erasistratus and Herophilus, modified his theory, and taught that the veins carry blood from the heart to the members, and that the arteries carry a subtle kind of air or spirits. Galen discovered that the arteries contained blood as well as “vital spirit,” and are not merely “air-pipes," as their name implies. With this exception, the theory promulgated by Aristotle remained the same from the Christian era down to the sixteenth century. For nearly one hundred years before the birth of Harvey it was well known that the blood is not stagnant in the body ; but until Harvey enunciated his doctrine the conception of a continuous stream returning to its source had not been thought of. It was believed that the blood moved irregularly, as regards both direction and speed, as air circulates in a house, or a crowd moves in the streets of a city. The functions of the heart as a motor were not comprehended. It was supposed that the septum of the heart, being pervious, permitted the blood to pass directly from the right to the left side ; that one kind of blood flowed from the liver to the right ventricle of the heart, thence to the lungs and general system by the veins, and that another kind flowed from the left ventricle to the lungs and general system by the arteries. The supposed function of the heart was to commingle blood and spirits, after sucking in these fluids, during diastole. Sylvius, a sixteenth-century anatomist, described the valves of the veins. Vesalius demonstrated the complete closure of the septum between the two ventricles. Servetus believed that the spiritus naturalis, as he termed the blood, is transformed in the lungs into spiritus vitalis, and he, therefore, was the true predecessor of Harvey in physiology. Yet the significance of the valves was unsuspected, and the idea of a complete pulmonary circulation was not fully comprehended.
Harvey believed that “wise men must learn anatomy, not from the decrees of philosophers, but from the fabric of nature herself.” He accordingly began his investigations into the movements of the heart and blood by examining them, as they actually go on in living animals. By experimenting on dogs, cats, pigs, serpents, frogs, etc., he most clearly demonstrated the anatomy of the heart, the veins, and the arteries. But he strove unavailingly to discover the channels by which the blood passes from the arteries to the veins. His conclusions may be summed
as follows : 1. The dynamical starting point of the blood is the heart, and not the liver. 2. The action of the right and left sides of the heart, auricles, ventricles, and valves is the same, the mechanism of both being for reception and propulsion of liquid, and not of air, since the blood on the right side, though mixed with air, is still blood. 3. The blood sent through the arteries to the
tissues is not all used, but most of it returns through the veins. 4. It is the contraction, not the dilatation of the heart, which coincides with the pulse, the ventricles, as true muscular sacs, squeezing the blood which they contain into the aorta and pulmonary artery. 5. There are no pores in the septum of the heart, so that the whole of the blood in the right ventricle is sent to the lungs, and thence back again to the left ventricle through the pulmonary veins, while in like manner the whole of the blood in the left ventricle is again sent into the arteries around by the smaller veins into the vene cave, and by them to the right ventricle again, thus making a complete circulation.
Harvey's conclusions are given in the following celebrated passage : “And now I may be allowed to give in brief my view of the circulation of the blood, and propose it for general adoption. Since all things, both argument and ocular demonstration, show that the blood passes through the lungs and heart by the auricles and ventricles, and is sent for distribution to all parts of the body, where it makes its way into the veins and pores of the flesh, and then flows by the veins from the circumference to every part of the centre, from the lesser to the greater veins, and is by them finally discharged into the vena cava and right auricle of the heart, and this in such quantity, or in such a flux and reflux, thither by the arteries, hither by the veins, as cannot possibly be supplied by the ingestor, and is much greater than can be required for mere purposes of nutrition, it is absolutely necessary to conclude that the blood in the animal body is impelled in a circle, and is in a state of ceaseless motion, that this is the act or function which the heart performs by means of its pulse, and that it is the sole and only end of the motion and contraction of the heart."
The discovery of the circulation of the capillaries between the arteries and the veins was made in 1661 by Marcellus Malpighi, of Bologna. Malpighi himself showed the capillary circulation to the delighted eyes of Harvey, who recognized in it the "missing link” of his own theory. Although Harvey's discovery, which he was nine years in perfecting, was perfectly capable of demonstration, it was attacked from all sides with the greatest acrimony. Hume remarks, as an evidence of obstinate adherence to preconceived opinions, that "no physician in Europe, who had reached forty years of age, even to the end of his life, adopted Harvey's doctrine of the circulation of the blood.
It would be interesting to review the arguments adduced to disprove this theory, but time forbids. It is simply the old story — first vituperation and then laurels. Fortunately Harvey lived long enough to wear his laurels, for his discovery was one that time and future research proved beyond the shadow of
doubt. Nevertheless, the College of Physicians and Surgeons of London ignored it, and nearly half a century after he had announced his discovery to the world, the Paris Royal Society of Medicine gravely listened to an essay which classed his discovery among the impossibilities.
Edward Jenner, the discoverer of vaccination, was born at Berkeley, on May 17, 1749. His father, the Rev. Stephen Jenner, was a rector, and came of a good family. He received his early education at Watton-under-Edge and Cirencester; after which he began his medical studies at Sodbury, near Bristol, under Mr. Ludlow, a surgeon of no great prominence. At twenty-one he proceeded to London, and won the good graces of the celebrated John Hunter, the founder of the Hunterian Museum, now one of the most famous of its kind in the world. He declined the post of naturalist in Captain Cook's second expedition in order to practice medicine in his native place. Like Harvey, his success in the practice of his chosen profession was marked. Jenner possessed many accomplishments and broad learning. He was a musician, a writer of no mean merit of both prose and verse, a biologist, a naturalist, and a geologist.
There was a popular belief among the rural people of his native county, Gloucestershire, that there existed an antagonism between cowpox and smallpox. The medical profession up to the time of Jenner, too learned to investigate this popular belief, supposed it "an imperfect induction of facts.” Jenner could not interest even John Hunter, his benefactor and friend, in this inquiry. In 1775 he instituted that systematic investigation which was destined to immortalize his name. He first proved to his entire satisfaction that under the term “cowpox two distinct and entirely different forms of disease had been confounded. Since only one of these protected against smallpox, failures were thus accounted for. He next ascertained that true cowpox, in order to prove prophylactic, must be communicated at a particular stage of the disease. A certain disease of the horse (grease) was known to produce vesicles and subsequent ulcers on the hands, almost indistinguishable from those of ordinary cowpox. Jenner, by raising vaccine vesicles on the arms of children by matter removed from the horses' necks, proved to his own satisfaction that all genuine cowpox comes from this disease. In 1798 he carried a drawing of the cowpox, as it appeared on the hands of a milkmaid, to London, for the purpose of interesting his friends in the subject. All agreed that the phenomena were “interesting and curious,” but none appreciated their practical importance. His theory was proved correct beyond a doubt when, in May, 1796, he inoculated one