arterial sclerosis. This disease is constantly being brought under our notice. Why so? Because particular signs are supposed to betoken it. But do they? Would it not be more true to say that they indicate its occasional origin? The point is that the search for a structural change has shifted its ground on to a functional disturbance—quite properly, as I think—and then incorrectly the arterial state has come to be regarded as due to the condition (sclerosis) of which it is in all probability the cause.
Then de motu cordis. Much work has been done of late upon the irregularities of the cardiac muscle. This work is well known to you and is of the very best, and not by a breath would I belittle it, for it is no doubt gradually emancipating a difficult subject of research from the mists of ignorance that envelop it, and by true Harveian method. But I may perhaps be permitted to say as a caution that it is possible to attribute to disease of the muscle more importance than by right belongs to it, and I believe it will be accepted in the future, as the result of further clinical observation, that many a case of arrhythmia, where we now seem to be inclining to muscular disease, is in truth an aberration of the higher cardiac centres, and as such no true example of pathological anatomy.[1]
- ↑ Catarrhal jaundice is for me another remarkable instance in point. We have always been so hard up for a morbid change in this malady that we have come to accept as sufficient the existence of a plug of mucin more or less natural to the part. But can it be that the proper performance of a function so important as the passage of bile is in danger of being arrested by an everyday circumstance such as this? Some temporary check to the driving power seems much more probable. The old ideas of splanchnic melancholia and abdominal megrims were not without warrant, and, indeed, they are worthy of rehabilitation.
