PREFACE. My object in the present work has been to lay before my professional brethren, more particularly students and younger practitioners, a system of medicine based upon the etiology, or what I would venture to call-the natural history-of disease. I do not, indeed, mean to imply that others have not preceded me in the same course, and with distinguished success. The profound and philosophical "Outlines of Pathology and Practice of Medicine," of Dr. Alison; the elaborate work on the "Principles of Medicine," of Dr. Williams; the eloquent as well as logical and scientific lectures of Dr. Watson; and the unfortunately as yet unfinished work of Doctors Bright and Addison, on the "Elements of Medicine," are more than sufficient evidence to the contrary. Without, however, in the slightest degree, detracting from the merits of these and similar works; it is, I believe, admitted that we are at present in need of a hand-book for students. It is hardly to be expected, and perhaps not to be desired, that a professedly elementary work should abound in originality, and therefore much that appears in the following pages must have been borrowed from others; but it cannot fail to add weight to any doctrine, which I would inculcate, to be able to enforce it by other and better authority than my own. At the same time I would add that, whatever is here advanced upon points of practice is mine, in so far as that I have compared it with my own observation and experience. I cannot, however, forbear to express my gratitude to Doctors Bright and Addison, of whom I have had the advantage of being the pupil as well as the honour of being a colleague; and to my late colleague, Dr. Babington, as well as to all my present colleagues, for much that I have acquired orally. I am aware of many omissions, others will, no doubt, detect many errors. I trust, however, that upon questions of practice, I have advanced little that will not meet the concurrence of the enlightened members of our profession. Where, however, I have advocated opinions differing from those commonly entertained, I have stated my reasons for doing so. I fear that I have thus been occasionally led into discussions, which all must feel to be tedious, and some may reckon superfluous, but my excuse must be my anxiety, to the utmost of my ability, to connect not only practice, but diagnosis also, with principles; believing, as I do, that empirical diagnosis can lead only to empirical practice. I hope that I may not fall short of the expectations of my friends as much as I have disappointed my own, though in regard to the latter, I would fain console myself with the words of the great moralist, that "to rest short of his own aims is incident to every one whose views are comprehensive, and whose fancy is lively; neither is any one satisfied with himself because he has done much, but because he can conceive little." UNION STREET, SOUTHWARK, October 23, 1855. MANUAL OF THE PRACTICE OF MEDICINE. PRELIMINARY OBSERVATIONS. MEDICINE, in its present state, may be defined to be the art of detecting and discriminating disease by the symptoms accessible to our investigations; and of removing, checking, or allaying it, by the different means, at our disposal, for influencing the vital actions of the living body. This art then presupposes a knowledge of health,—that is, of the functions of the body, and the forces by which it is actuated; of disease, that is, of the changes both structural and functional from the healthy state, and of the laws which regulate the sequences of those changes; and-of the action of external and internal agents and remedies, upon the system, both in health and disease. Now if the above sciences were perfect, medicine would consist in a collection of corollaries from the truths contained in them, since a knowledge of healthy structure and function would enable us at once to appreciate any departure from it, and a knowledge of the changes in structure and function, which constitute disease, and of the laws which regulate the sequences which those changes observe, which lead us at once to recognize the nature and origin of the disease; whilst a knowledge of the action of remedies would enable us at once to select and apply the most appropriate. But as at present these subsidiary sciences are by no means perfect, there remains much which can only be learned by experience gained from the practice of medicine itself, and therefore medicine has its own truths and principles, which we cannot at present deduce from any other branch of knowledge. The theory of medicine must in fact still be regarded as an inductive science of itself, though we are at liberty to take for granted the established truths of those to which we have alluded, and in the following pages shall rarely enter into any examination of them. |