PREFACE TO THE FIRST EDITION. A BOOK should be judged and appreciated with some direct reference to its declared purpose. The present volume is intended as an aid to young men who have engaged in the study of medicine, to physicians who have recently assumed the responsibilities of practice, and to my fellow-professors of the institutes of medicine, and private instructors, who have felt the difficulty of communicating to the first two classes the knowledge which they are earnestly seeking to acquire. Having been a teacher of medicine for thirty years, and a student more than forty, I must have accumulated some experience in both characters. I have prepared and printed for those in attendance on my lectures, many successive manuals or text-books; I have also written and published numerous treatises upon medical subjects in general. The first I have endeavored to improve, edition after edition, to render them more available and useful to those in whose hands they were placed. Of the latter, some of which have been favorably received, I have endeavored to learn and avoid the defects, to the best of my ability. The following pages are the result of a careful collation of what has been esteemed most valuable in both, with such matter as continued study and enlarged experience have enabled me to add. May I hope that they will not be altogether unworthy the approbation of my professional brethren! It was necessary that the book should be as compendious as possible, or it would not have been acceptable to the student, upon whose time there are so many claims; it was also necessary that it should be written in the simplest and plainest style, that it might not be unadapted to the wants of those whose preliminary education has been hurried and imperfect: yet it was absolutely necessary that nothing essential to a fair development of the whole subject attempted should be left out. While a judicious selection of topics was therefore demanded, a critical rejection of such details as might properly be omitted, was as imperatively required. A full statement of elementary principles was called for on the one hand, and all attainable brevity of discussion was equally indispensable on the other. In the execution of a task so delicate as this, I cannot hope to have attained complete success. I shall be judged most kindly and indulg ently, I am sure, by those best qualified to appreciate the actual difficulties encountered. CHARLESTON, August, 1855. CONTENTS. Introductory remarks; definitions unsatisfactory, from the difficulty of apprehend- Diseases variously divided-functional and organic, local and general, and so on; all manifest themselves in perversion of the natural and normal actions, or in alteration of structure or composition, progressive, and tending to further change 36-37 Causes of disease variously distinguished; proximate and remote; predisposing PREDISPOSING CAUSES-predisposition truly a passive state; not to be regarded, therefore, as causative in the ordinary sense; may be original or acquired, per- manent or temporary; of internal constitution, or external source; hereditary, or of race, or tribal; of temperament, idiosyncrasy, or personal habit; of sex, or age, or color, or climate; not easily distinguished always from the idea or conception of proximate cause, as impressing often the nature or form of in- 39-44 EXCITING CAUSES-the immediate contingencies which bring on an attack, almost synonymous with remote, as the books call them, efficient causes; divided into INCIDENTAL CAUSES, include all such contingencies as may become injurious by excess, intensity of effect, unfitness or abruptness of application, though in themselves innocent, useful, or even necessary; treated of under the several heads of the Climatic or Geographical, Dietetic, Personal, and Social 1. The Climatic comprise all atmospheric, topographical, and geological conditions; the prevailing winds, temperature, moisture, alternations, and migrations; the geographical distribution of diseases—a topic not 46-49 4. The Social Condition-civilized and savage, in town and country, in high and low life; occupations, amusement-sedentary and active— SPECIFIC CAUSES-such agents as are, in their own nature, noxious. Poisons: classed as the Vegetable, Mineral, Animal, and Aerial. 1. The Vegetable Poisons are numerous, many of them familiarly known as medicines, emetics, cathartics, narcotics, acids, alkalies, and alka- 2. Mineral Poisons-not abundant in nature, but multiplied by art, as the oxyds and salts of metals, acids, &c.; these too received into our 3. Animal Poisons-normal secretions, such as the venom of the serpent, the wasp, hornet, &c.; natural secretions, changed by disease-as the saliva in hydrophobia; solids and fluids, similarly altered-as in ma- lignant pustule; new productions, secretions or excretions. Contagion -a new and peculiar product of diseased action, capable of reproducing that action-therefore germinative, and probably organic; in form, palpable and impalpable; diffusible in the blood, pus, and lymph; coincident with both animalcular and vegetable growth; disseminated in the atmosphere; concentrated in, and adherent to, fomites; tests of its presence and influence sought for; quarantines discussed 65-82 4. Aerial Poisons-inordinate proportion of any of the constituents of at- mosphere, as of carbonic acid in wells; change of condition, as in the allotropic state of oxygen known as ozone; irrespirable gases produced naturally or artificially, and mingled in the air, as sulphuretted and carburetted hydrogen; effluvia of animal origin: a, exhalations from living and healthy bodies-ochlesis-the "crowd poison" of Gregory— b, from collected excretions, as in privies-c, from putrefaction of ordi- nary animal matters: miasmata of uncertain origin. Malaria-the existence of such specific poison, matter of clear and rational inference, however disputed; its principal source, the decay of vegetable matter; it is probably organic, cryptogamous, or animalcular; abundant in known localities; not found in others; gives rise directly to periodical THE ENDEMIC AND EPIDEMIC ETIOLOGY OF DISEASE next treated of separately 121-124 Humoralism and solidism discussed; vitiations of the composition of fluids and 125-127 DIAGNOSIS empirical and scientific; doubly related to Prognosis and Therapeutics; scientific methods progressive and much improved; aid us most in special diagnosis, the separation of each case from every other by its individual pecu- liarities and complications; general diagnosis greatly dependent on, and pro- moted by, pathological anatomy, the true value of which, its application, and Some of the more familiar and important described and investigated in their rela- tions to Diagnosis and Prognosis; the distinction between the objective and the subjective, signs and symptoms; the importance of a careful study of the first, the cautions necessary in trusting to the latter; malingering-cases of infants, mutes, and idiots; of hysterical affections, and of maladies in which suffering is the prominent part; taken up in order as they affect the physiological THE CIRCULATORY-the pulse commented on; a comparison instituted between its 132 133-137 THE DIGESTIVE-the morbid appearances of the tongue; nausea, vomiting; explo- ration of the abdomen, and observation of matters ejected and alvine actions THE RESPIRATORY-dyspnea, orthopnoea, cough, and expectoration; exploration of the thorax; percussion, auscultation, mediate and immediate; the stethoscope described; respiratory and vocal sounds, natural and morbid; rhonchi, or râles; |