MISCELLANY. 



123 



us at last ceases in the system to be syphi- 

 'is, and becomes an early decay. 



It is curious to consider the various 

 morbific agents at work within our bodies, 

 the lines in which they work, and their 

 seats of action. These as yet have been but 

 little studied, and deserve attention. Thus, 

 it is very doubtful if scarlatina begins in the 

 blood, as we should all be apt to say, rather 

 than in any other tissue or fluid. Let it be 

 our object to find out where all these begin 

 within the body, and how they enter the 

 body. In future, I hope, comparative pa- 

 thology, which is just beginning to be stud- 

 ied, will teach us much; for in our bodies 

 we men have many organs which are of lit- 

 tle or no use to us, and are only relics of a 

 former state of being. What, for instance, 

 is the comparative anatomy of tonsils V 

 Were I to make a man, I do not think I 

 would put tonsils in him. Yet these, and 

 such like organs, in accordance with the 

 general law, are more prone to disease than 

 are the others which are of real use in the 

 system. I remember the case of a man 

 who had a permanent vitelline duct. He 

 had been out on a cold day, and the motion 

 of the intestines twisted them in a mass 

 round this persistent duct, and he died. I 

 made a preparation of the duct, and wrote 

 under it, " Cui vitam atque mortem dedit 

 diverticulum." Every part of the body is 

 alive, and has its own individual life and 

 pathology, whether it be immediately re- 

 quired or not ; only, if not required, it is 

 more prone to disease than if it were. I 

 could, for instance, suppose a foetus of four 

 months going to the doctor and saying : " I 

 am going all wrong ; my Wolffian bodies are 

 disappearing, and kidneys are coming in 

 their stead." Yet that is as much a con- 

 dition of disease as some of those conditions 

 of which I speak. 



It is of the utmost possible importance, 

 then, to be able to tell what we have and 

 what we have not to cure. How often do 

 we find people trying to do what is impos- 

 sible ! Some women have no more vital ca- 

 pacity than a canary-bird ; they are con- 

 stantly ill, and it is useless to attempt to 

 make them well. A man came to me, and 

 said : " I don't know what to do with So- 

 and-so. I have given her every thing I 

 eould think of, and she will not get strong." 



" Why," I said. " you have been trying to 

 put a quart into a pint pot. You cannot 

 make her strong, and never will." 



So, when a new instrument or mechani- 

 cal means of diagnosis is introduced, we 

 must try to make ourselves masters of it, so 

 as to be able to use it aright, even though 

 this is troublesome to ourselves ; only we 

 must beware of applying the knowledge 

 thus acquired too early to practice. Thus, 

 as regards the thermometer, doubtless it 

 yields us most valuable information, but we 

 must beware of using it as a guide to our treat- 

 ment until we have a more complete knowl- 

 edge of the condition of bodily temperature. 



But after the physical comes the vital 

 diagnosis. It is well to know exactly what 

 is the condition of each part of the system ; 

 but to what is the wrong due ? That no 

 weighing or measuring can give you only 

 experience. A man has pneumonia that 

 is a too vague fact ; what are the dynamics 

 of the disease ? One man with a pneumonia 

 will get rapidly well and be right again in a 

 few days, whereas another man will not get 

 well at all. So, in different individuals, a 

 form of disease apparently the same may be 

 different from the beginning, and this we 

 cannot always make out in our diagnosis, 

 especially in internal disease. In skin-dis- 

 eases we can do better. 



During the last week I had been called 

 on, as most of you know, to form a diag- 

 nosis of the workings of the mind. Here 

 the break-down may be the first sign of the 

 diseased condition, just as it may be in 

 heart-disease, peritonitis, and a score of 

 other diseases. A man, after racing up a 

 hill, finds himself breathless and spitting 

 blood. He comes to you, and you find 

 heart-disease. It does not mean that the 

 heart-disease was produced by running up 

 the hill ; it only means that an organ, equal 

 to its ordinary duties, failed when unusual 

 stress came to be laid upon it. So is peri 

 tonitis often the result of disease previously 

 latent, but brought on by exposure to cold, 

 or some such agency. Some men say that 

 such cases as those of doubtful sanitj 

 should not be taken up by us that ordi 

 nary men are quite as well fitted for finding 

 out the truth as we are, with all our train- 

 ing. If so, all I say is, that it is no honoi 

 to us that it is so. 



