IRREGULAR GROWTH.-(1) Hypertrophy: its distinction from inflammation, and from various accidental causes of increased dimension: laws of renewal after waste renovative hypertrophy of muscle; of gland-nephritis, bronchocele ; fortifying hypertrophy-rickets; hypertrophy from withdrawal of pressure— cranial bones, teeth. (2) Atrophy; from disuse of organs; muscular; osse- ous; glandular; relation to local anemia; progress and mode of origin of atrophic changes; accidental atrophy from disease of arteries; brain; kid- ney; effects of secale cornutum: pressure-difference in its effects, as it is constant or remitting. (3) Morbid changes of consistence, and their relation I. Fibrinous effusions; ulterior changes of fibrin; collateral illustrations from anatomy of intra-vascular clots.-II. Generation of cytoblasts.-III. Their ulterior progress; pus; glomeruli-their relation to dissolution of blood; sup- puration on mucous surfaces, in solid organs; distinctions of adhesive and suppurative inflammation, and circumstances determining them.-IV. Vas- TUMOURS; Description of them severally, as to their structure and usual sites: (1) Tegumentary-cutaneous, mucous; (2) Vascular-arterial, venous; (3) Fatty; (4) Fibrous; their calcification; (5) Cartilaginous; their methods of ossification; (6) Bony-simple, complicated with cancer; membraniform osteophyte of skull in pregnant women; (7) Cystic-follicular, vesicular, bur- sal, serous; contents of cysts; growths from wall of cysts; compound ova- rian cysts; analysis of their anatomy; (8) Cancerous; their type illustrated in encephaloma of the eye; its anatomical ingredients: scirrhus; colloid; usual sites of cancer; distinction of primary and secondary: modes of dis- semination-by contact, by veins, by lymphatics: Can it be infected by inocu- PATHOLOGICAL RECAPITULATION: (1) Tumours by accumulated secretion; (2) Hy- pertrophic tumours; partial hypertrophy; adjunctive hypertrophy; (3) Hyper- trophic tumours with conversion of tissue; (4) Eliminative tumours. What is the malignity of cancer? Operations for its removal; the pathological prin- SCROFULA:-Tubercle its essential and diagnostic product. Distinction of scrofula from sub-inflammatory and atrophic processes occasioned by mere debility. Experiments on the artificial producibility of tubercle. Hereditary transmission of scrofulous diathesis, as a developmental peculiarity. Mate- rial of tubercular deposits; its microscopical characters; is it an inflamma- tory product? Organs preferentially invaded by tubercle: its anatomical relations to the natural structures. Diseases with which tubercular deposi- tion is incompatible: diseases with which it has affinity; fatty degenerations. Pathological generalizations as to tubercle and the tubercular diathesis: its contrast with Cancer. Therapeutical influences against tubercle. NERVOUS DISEASES:-Generalization of Normal Nervous Phenomena, and of their respective relations to Anatomical Divisions of the Nervous System. I. Physical morbid phenomena; (1) Anæsthesia; (2) Subjective Sensations; (3) Paralysis; (4) Involuntary Movements:-II. Mental morbid phenomena. Causes of abnormal excitement or depression in central organs-humoral, Analysis of nervous sympathies: (1) Co-ordinate; (a) homogeneous or augment- ative; (b) heterogeneous or reflex: (2) Ascensive and Descensive. Therapeutical Control over Nervous Centres; Cold; Belladonna; Strychnine; EVACUATIVE MEDICINES in relation to Humoral Pathology. Critical discharges in disease-gout, rheumatism, cutaneous eruptions: humoral disease in con- dition of latency, and in act of explosion. Medicinal influence over excre- tions. Excretive drugs having local affinities of action; diuretics: query as to effect on real act of excretion. Vicarious and compensative excretion; diaphoretics in diabetes. Summary of results: derivative medicines; medi- cines modifying catalysis of blood: action of saline purgatives by way of exos- MORBID POISONS: their distinction from common poisons; generalization of their phenomena, constitutional and local'; illustrated in case of continued fever. Pathology of infection, illustrated by inoculation of smallpox: imme- diate increase of poison: subsequent immunity of patient. What constitutes susceptibility to morbid poison? Peculiarities of syphilitic and vaccine infec- tion. Mildness of inoculated smallpox. Paludal poison: Cholera. Theories of infection: contagium animatum? illustrations of parasitic disease; their dissimilitude from phenomena produced by morbid poisons. Ferment- ation theory? dissimilitude of the infective process from any known catalytic action. Origin of the several contagia in the blood? in its descensive metamor- phosis, or in the humoral products of organic waste? Summary of results. Pathological principles of anti-zymotic cure and pre- vention. A COURSE OF LECTURES IN GENERAL PATHOLOGY. INTRODUCTORY LECTURE. Definition of Pathology as a Science; its dependence on anatomical, chemical, and clini cal observations; its relation to Physiology; Disease, what? prevalence of exterior causation in producing it; symptoms and products of disease are determined by types of healthy structure and function; reaction; arrest or excess of development; norma of disease; query as to disease essentially independent of exterior cause; hereditary developmental diseases; spontaneous declensions of type? influence of Pathology in improving treatment of disease; pleasures and rewards of the study. GENTLEMEN: In approaching the frontier of a new country, we naturally desire to possess some previous general information as to the objects which will fall beneath our notice; and thus you, to-day, on the threshold of another study, may reasonably expect to be informed by me as to its subject-matter, and limits, and relations. Pathology (rátovs óyos, the discourse of whatsoever is suffered) etymologically implies the Science of Disease. In inquiring with you at some length in what sense these two words (science and disease) are, or ought to be, used in the definition just given, I believe that I may best fulfil the explanatory objects of an introductory lecture. Hereafter, I shall have something to say of the word disease; meanwhile, I will take for granted that each of you attaches a familiar meaning to the word; and in that sense, for the moment, I will leave it. The other word, science, is always in our mouths; let us ask with what definite meaning it is used. If we distinguish an infinite diversity in the objects of sense-if our eyes acquaint us with a thousand grades and combinations of colour-if our palates discriminate manifold differences of taste and flavour-if our ears inform us variously of the pitch and rhythm of sounds-if, through the same or other inlets of sense, we are enabled to recognize the several degrees of cohesion, of weight, of magnitude, 12 RELATION OF PATHOLOGY TO PHYSIOLOGY. extensive observation; and any endeavour to establish it on another foundation, or to spin it forth from the devices of one's imagination, cannot but prove impotent and fruitless. Two years ago, I availed myself of the opportunity offered by my commencing connection with this School, to explain at length what I conceived to be the true method of pathological study;* and I endeavoured, on that occasion, to illustrate the manner and the proportion in which the mind and the senses must co-operate (or rather, in which the senses must follow the guidance of the intellect) for the purposes of scientific investigation. Therefore, I refrain from dwelling at present on this subject, and pass to other points, relating rather to the limits and affinities of the science. The phenomena with which the pathologist has to deal are (as I have already mentioned to you) those which occur in the ancillary studies of morbid anatomy, morbid chemistry, and clinical observation; and it is almost superfluous for me to tell you, that these studies presuppose a knowledge of health. All the phrases of pathological observation imply that knowledge as their standard. When you say, handling an organ,-brain or lung,—that it is hard or soft, or very hard or very soft, you mean that the brain is soft as compared with healthy brain, the lung dense as compared with healthy lung. When you say that a man's pulse is quick, or that his pupil is contracted, you mean quick as compared with a healthy man's pulse, contracted as compared with a healthy man's pupil, under similar circumstances. When you say that colocynth is a purge, or morphia a narcotic, you mean that a healthy man would discharge more feces, or have more sleep, under the influence of these drugs than if left to himself—and so on. What, then, you may ask, is the relation of Pathology to Physiology? When the latter word is used in its true (which is also its largest) sense, it includes the former; it implies, namely, the total science of life, whether in health or in disease. In common conversation, however, "physiology" is often restricted to denote only the science of life in health; and it is then used in direct contradistinction from "pathology," as the science of life in disease. No doubt it is convenient for some purposes, that there should be a division of labour in these subjects; that some men should devote themselves especially to observe and explain the phenomena of the healthy body,-others especially to the task of unfolding the more intricate mysteries of disease; but, gentlemen, whether you consider pathology to be a part of physiology in the act of its application to medicine, or whether you view it as a separate study standing in contrast to physiology, in either case let me impress on you that the science is really one, the method of observation and research one, and that any supposed science of disease must of necessity be crude or fictitious, unless it be a direct deduction from the knowledge of health. Your observations will be utterly valueless, if you do not * On the Aims and Philosophic Method of Pathological Research: An Inaugural Address delivered at St. Thomas's Hospital. London, 1848. |