552 



MEDICAL SCIENCE AND PRACTICE. 



Other illustrations of the progress that has 

 been made in the sedulous and laborious study 

 of forms of disease are afforded in the case of 

 nervous disorders, which are now traced to 

 general changes taking place in other parts of 

 the system; and those processes have been 

 coune'eted with certain signs by which they are 

 recognized clinically. Even in psychological 

 medicine insanity has been demonstrated to be 

 tho result of definite cell-change. The smallest 

 degree of progress has been made in what are 

 termed the general diseases of the system ; but, 

 among these, diseases of the blood-elements 

 have received certain definite explanations 

 gout has been elucidated in its chemical results, 

 aud diabetes has been studied as a question of 

 physiology but little as a disease, while of tet- 

 anus, chlorosis, and scrofula " but little more 

 is known than the descriptions of Hippocrates 

 tell." 



Great and wide progress has been made in 

 the study of the signs and symptoms of disease. 

 A definite value and explanation have been 

 given to the symptoms, and the signs of disease 

 have received their true meaning. A direct 

 effect of disease has been observed as the nat- 

 ural center for a group of symptoms, which, 

 without such explanation, were isolated and 

 unintelligible. "While local lesions have been 

 clearly defined, the " constitutional " effects 

 have been more observed ; and these effects, 

 always recognized as they have been by signs 

 to which a purely empirical value was attached, 

 are now measured with the certainty of scien- 

 tific observation. The relations of the topical 

 disease to the whole system usually the main 

 inquiry in each case are thus determined. 



The study of disease by the methods of 

 investigation represented by the stethoscope, 

 ophthalmoscope, thermometer, and by urino- 

 scopy, has been elaborated and formulated to an 

 extent which the authors of those methods did 

 not dream of. Through them a certainty and 

 precision are afforded to certain signs which 

 must in all cases be inquired into, but which, 

 before the use of such means, were most vague 

 and nndefinnble. Electricity, also, has been 

 made to contribute materially to the more pre- 

 cise determination of the general effects and 

 conditions of disease; and other means, of 

 smaller and more limited scope, have assisted 

 to build up a broad basis of semeiology which 

 js of the utmost value because it supplies a pos- 

 itive estimate of the vital powers and the con- 

 stitutional relations of local disease that are 

 fundamental factors in every case, and could 

 otherwise only be vaguely guessed. 



The study of children's diseases has been 

 greatly accelerated by the multiplication of 

 hospitals for children. Thirty years ago there 

 was not a single hospital set apart for children 

 in England and America, and investigation in 

 this branch of the science could be pursued 

 with any degree of success only in Paris. 

 Now, London has several special children's hos- 

 pitals^ and similar institutions are established 



in every large town in England, while chil- 

 dren's wards have been provided in most of 

 the large hospitals. Nearly the same is the 

 case in the United States and Germany, and 

 almost everywhere throughout Europe tho 

 opportunities for the study of the diseases of 

 children are almost as numerous as for the 

 diseases of adults. The fruits of the labors 

 that have been pursued under the advantages 

 thus afforded may be counted with satisfaction. 

 The vague phraseology which served for years 

 to conceal ignorance respecting the affections 

 of childhood has been, to a great degree, done 

 away with. Physicians no longer talk of 

 worm fever, remittent fever, gastric fever, etc., 

 as distinct diseases, but recognize under these 

 names the one disease, typhoid fever, varying 

 in severity, but marked always by its own 

 characteristic symptoms. Half a page in a 

 hand-book was all that was to be found, thirty 

 years ago, concerning heart-disease in child- 

 hood ; while at the present day the frequency 

 of heart-disease has been fully recognized, and 

 it has been studied with as micute a care in 

 the child as in the adult. The various inflam- 

 mations of the respiratory organs are no longer 

 looked on as a whole, but each is referred to 

 its proper class. That once almost unrecog- 

 nized disease, diphtheria, has been studied 

 with the greatest care; its relation to mem- 

 branous croup has been investigated, and the 

 close connection of the two has been demon- 

 strated. Much light has been thrown on the 

 various diseases of the nervous system. The 

 so-called essential paralysis of infancy has been 

 traced by the researches of Messrs. Eoget and 

 Damaschino to its proper source, and the 

 pseudo-hypertrophic muscular paralysis of Du- 

 chenne has been the means of affording a new 

 and important addition to our knowledge of 

 the pathology of early life. Corresponding 

 advances have been made in the therapeutics 

 of children's diseases. 



Physicians and surgeons have gained knowl- 

 edge concerning the relation of the various 

 organs of the -body and their affections, the 

 value of which is beyond estimation, from 

 investigations pursued on animals; yet the 

 opposition to vivisection is maintained with 

 unabated zeal. The duty of the state to en- 

 courage rather than discountenance researches 

 of this kind was admirably presented at the 

 International Medical Congress, by Mr. John 

 Simon, who maintained that all that we know 

 or can know of the causes of disease is, and 

 must be, learned by experiment. He showed 

 that the experiments that instruct us on the 

 subject are of two kinds: scientific experi- 

 ments, carefully, pre-arranged and compara- 

 tively few, performed in pathological labora- 

 tories, and for the most part on other animals 

 than man ; and " the experiments whicli acci- 

 dent performs for us, and, above all, the in- 

 calculably large amount of crude experiment 

 which is popularly done by man on man under 

 our present ordinary conditions of social life." 



