stone of the kidney or gall-bladder, perityphlitis, ovarian dropsy, which in the earlier part of the 19th century were either fatal or crippling, are now taken promptly and safely in hand, and dealt with successfully. Even for internal cancer cure or substantial relief is not infrequently obtained. We have said that this advance is often quoted, not very wisely, to signify that in modern progress “medicine” has fallen behind surgery—as if the art of the physician were not one and indivisible. That certain Fellows of the College of Physicians (especially in gynaecology) have personally taken operative procedures in hand is some good omen that in time the unreal and mischievous schism between medicine and surgery may be bridged over.
In the department of abdominal disease progress has been made, not only in this enormous extension of means of cure by operative methods, but also in the verification of diagnosis. The first recognition of a disease may be at a necropsy, but then usually by irresponsible pathologists; it is another matter when the physician himself comes under rebuke for failing to seize a way to cure, while the chance remained to him, by section of the abdomen during life. The abdomen is still “full of surprises”; and he who has most experience of this deceptive region will have least confidence in expressing positive opinions in particular cases of disease without operative investigation. Besides the attainments mentioned above, in respect of operative progress, many important revisions of older rule-of-thumb knowledge have come about, and not a few other substantial discoveries. Among the revisions may be adduced some addition to our knowledge of dyspepsia, attained by analytic investigations into the contents of the stomach at various stages of digestion, and by examining the passage of opaque substances through the primae viae by the Röntgen rays. Thus the defects, whether of this secretion or of that, and again of motor activity, the state of the valvular junctions, the volume of the cavities, and their position in the abdomen, may be ascertained, and dealt with as far as may be; so that, although the fluctuations of chemical digestion are still very obscure, the application of remedies after a mere traditional routine is no longer excusable. In our conceptions of the later stages of assimilation and of excretion, with the generation of poisons (auto-intoxication) in the intestinal tract, there is still much obscurity and much guess-work; yet in some directions positive knowledge has been gained, partly by the physiologist, partly by the physician himself. Of such are the better understanding of the functions of the liver in normal catabolism, in the neutralization of poisons absorbed from the intestines or elsewhere, in the causation of jaundice, and in diabetes [Bernhardt Naunyn (b. 1839) and F. W. Pavy]. Nor must we forget the unfolding of a new chapter of disease, in the nosology of the pancreas. In diabetes this organ seems to play a part which is not yet precisely determined; and one fell disease at least has been traced to a violent access of inflammation of this organ, caused perhaps by entry of foreign matters into its duct. The part of the pancreas in digestion also is better understood. The part of the spleen in the motley group of dyspepsias and anaemias, conspicuous as it often is, still remains very enigmatic.
The peritoneum is no longer regarded with awe as inviolable; by modern methods, if not as manageable as other lymphatic sacs, it is at any rate accessible enough without considerable risk to life. Not only in its bacteriological relations are the conditions of peritonitis recognized in its various kinds, but also the state known as “shock” turns out to be quasi-mechanical, and avoidable by measures belonging in considerable part to this category. Thus, by the avoidance both of toxaemia and of shock, peritonitis and other dangers of the abdomen, such as strangulations or intussusceptions of the bowels, formerly desperate, can in many cases be dealt with safely and effectively.
Our knowledge of diseases of the kidneys has made no great advance since the time of Richard Bright. In the sphere of physiology and in the interpretation of associated arterial diseases much obscurity still remains; as, for instance, concerning the nature of the toxic substances which produce those bilateral changes in the kidneys which we call Bright’s disease, and bring about the “uraemia” which is characteristic of it. Lardaceous disease, however, here and in other regions, now appears to be due to the specific toxins of pyogenetic micro-organisms. In stone of the kidney a great advance has been made in treatment by operative means, and the formation of these stones seems to recent observers to depend less upon constitutional bent (gout) than upon unhealthy local conditions of the passages, which in their turn again may be due to the action of micro-organisms.
To Thomas Addison’s descriptions of certain anaemias, and of the disease of the suprarenal capsules which bears his name, something has been added; and W. Hunter’s researches on the severer anaemias are doing much to elucidate these subtle maladies. And on the influence of these inconspicuous bodies and of the pituitary body in sustaining arterial blood pressures physiologists have thrown some important light.
The secret of the terrible puerperal septicaemia was read by J. P. Semmelweiss (q.v.), wherein he proved himself to be the greatest of Lister’s forerunners (see Lister).
The diseases peculiar to women (see Gynaecology) have received attention from early times, but little progress had been made in their interpretation till the 19th century. In the middle part of the century, by a natural exaggeration of the importance of newly-discovered local changes in the pelvic organs, much harm was done to women by too narrow an attention to the site, characters and treatment of these; the meddlesomeness of the physician becoming in the temperament of woman a morbid obsession. To James Matthews Duncan (1826–1890) we chiefly owe a saner and broader comprehension of the relative importance of the local and the general conditions which enter into the causation of uterine and ovarian disorders. In operations for diseases of the pelvis, ovarian dropsy, cancer of the uterus, and other grave diseases of the region, success has been stupendous.
In the subject of diseases of the skin much has been done, in the minuter observation of their forms, in the description of forms previously unrecognized, and in respect of bacterial and other causation and of treatment. The comparison of observations in various climates and peoples has had some weight; while in the better knowledge of their causes their treatment has found permanent advantage. Not only is the influence of bacteria in the causation of many of them newly revealed, but it is now recognized also that, even in skin diseases not initiated by microbic action, microbes play a considerable and often a determining part in their perpetuation; and that the rules of modern aseptic surgery are applicable with no little success to skin therapeutics. We have learned that “constitutional” causes play a smaller part in them than was supposed, that a large number of diseases of the skin, even if initiated by general disorder, are or soon become local diseases, being, if not initiated by local infection yet perpetuated thereby, so that, generally speaking, they are to be cured by local means.
The diseases of children have not lacked the renewed attention, the successful investigation, and the valuable new lights which have been given to other departments of medicine. That infantile paralysis is an infection, and that its unhappy sequels are now treated with more hope of restoration, has been indicated already. Infantile diarrhoea has also been recognized as a common infection (Ballard), and the means of its avoidance and cure ascertained. The conditions of diet and digestion in children are now far better understood, and many of their maladies, formerly regarded as organic or incomprehensible, are cured or prevented by dietetic rules. Rickets, scurvy and “marasmus” may be instanced as diet diseases in children. Acute inflammation of the ear, with its alarming extensions to the cerebral cavity, is now dealt with successfully by surgical means, and infected sinuses or even encephalic abscesses are reached and cleansed. The origins, kinds and processes of meningitis are more clearly distinguished, and referred each to its proper cause—for the most part bacterial.
As by the discovery of stethoscopy by Laennec a new field of medical science and art was opened up, so, more recently, inventions of other new methods of investigation in medicine
