INTRODUCTION

Before entering upon the study of any subject, it is of moment that the student be thoroughly convinced of the importance of the knowledge which he is about seeking to acquire, since his zeal in its pursuit will, in most cases, be in proportion to this conviction. We will, therefore, before entering upon the subject proper of this book, present in few words, some considerations on the importance of a study of morbid anatomy as revealed by post-mortem examinations.

The necessity of a study of anatomy and physiology by a medical student, is now so universally recognized, that an attempt to prove its importance would seem deserving only of ridicule; but the ignorance of many practitioners on the subject of morbid anatomy, shows that this study has yet to vindicate its claim as a necessary branch of a medical education.

From a purely theoretical standpoint, the educated physician—one whose motto is Esse, non videri—after combating a disease in vain, should not feel content to remain in ignorance of its real nature, so far as discoverable by anatomical changes, capable of being recognized after death, even had he no prospect of adding thereby one jot to his practical acquaintance with disease or to his power to combat it; yet his scientific conscience (if we may be allowed the expression) ought not to rest satisfied until, in all doubtful cases, his ante-mortem diagnosis be confirmed or overthrown, and his conception of the case completed in all its details by a post-mortem examination.

18Besides this purely individual scientific interest, there are weightier practical reasons for an acquaintance with this branch of medical science by the physician as practitioner.

Among the almost innumerable questions upon medical, theological, and miscellaneous subjects which the American public feels at liberty to propound to its medical advisers, none are of more frequent occurrence and none are more justifiable than the two: “What is the matter with the patient?” and “Will he, or can he, recover?” and to none is an answer more imperatively demanded. The public very naturally, and with reason, requires on the part of a physician the ability to make a diagnosis and a prognosis. It will not be satisfied with being told that the name of the disease is of no importance, that the doctor only wants to hear the symptoms; that he does not cure diseases, but removes the symptoms of disease, &c. Only an exceedingly well-trained public will accept these truisms as an equivalent for diagnostic skill. Hence, it is the physician’s interest, as well as his duty, as we shall see, to seek, in all cases, to make a diagnosis, no matter how difficult the task may prove to be. The question how far his treatment will be modified by his diagnosis is a question of therapeutics, and does not belong here; but certain it is, that a mere combatal of the symptoms as isolated phenomena cannot be regarded as fulfilling the whole duty of a conscientious physician.

The ability to make a diagnosis, and consequently prognosis, depends upon a knowledge of pathology, with a knowledge of symptoms as signs of pathological states and changes; and as such they must be critically examined and their true import discovered, if possible. Thus treated, we arrive, by various processes of reasoning, at a diagnosis, under which the symptoms fall into their natural order of importance, and we run but little risk of contending with remote subjective symptoms (of great importance in differential 19therapeutics) to the neglect of more important, though perhaps less prominent ones.

Besides this, we are, in a measure, prepared to foretell the probable course of a disease, and can, therefore, in many cases, adopt anticipatory measures, while in all we will be guarded against the error, so often committed, of ascribing to the remedy used the so-called “aggravations,” which are often only natural symptoms of the unchecked and, perhaps, entirely uninfluenced morbid process. Such knowledge serves thus, by purifying our experience, to guard us against self-deception, and to prevent us from misleading others by reports of cures of diseases existing only by virtue of a false diagnosis.

A knowledge of pathology, furthermore, places in our hands a thread which can guide us through the labyrinth of our vast materia medica, and which enables us, from the myriad of symptoms, to eliminate the non-important ones. It shows us the “bearings” of the medicines and their various specific ranges, thus materially facilitating the choice of a remedy.

Again, medical science is virtually based upon pathology, and we see, therefore, how important, nay, how absolutely necessary, to the progress of the former is the study of the latter. The practice of medicine as an art can never be advanced knowingly by those who neglect its cultivation as a science. While each one may practice the art according to his own convictions, true medical science stands above all the belittling, bigoted prejudices of the schools. Here, every one claiming the name of an educated physician can and ought to work.

The wild vagaries of former ages, when philosophy set up purely theoretical views, under which observed phenomena were compelled to arrange themselves, have warned the present age to be guided solely by sober and exact observations and investigations; and it needs no proof that, in the 20advancement of our knowledge of disease, these are best accomplished by frequent post-mortem examinations, which thus become a necessary adjunct to a proper study of pathology.

In all cases of interest, therefore, the physician should feel it a duty which he owes to himself and the profession at large, to seek permission to make a post-mortem examination; but in order that the fullest benefit may be derived from the same, he must know how to look for what he is in search of, and how to recognize it when found.

To furnish this knowledge is the object of the following pages, to which we herewith introduce the reader.

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