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Cooke's Morgagni, Vol. 1, pp. 417-418. I cannot too warmly commend to young clinicians the reading of Morgagni. Morgagni's life had as much influence as his work. In close correspondence with the leading men of the day, with the young and rising teachers and workers, his methods must have been a great inspiration; and he came just at the right time.
Anatomists and histologists have more perfectly demonstrated the muscle fibers of the heart and the structure at and around the valves; the physiologic chemists have shown more clearly the action of drugs, metals and organic solutions on the heart; and the physiologists and clinicians with laboratory facilities have demonstrated by various new apparatus the action of the heart and the circulatory power under various conditions.
It is now generally agreed by all scientific clinicians that it is as essential almost more essential to determine the diastolic pressure as the systolic pressure; therefore the auscultatory method is the simplest, as well as one of the most accurate in determining these pressures.
By a series of carefully collated observations as to how regions, seasons, and years differed from each other, they succeeded in laying the basis of a rational study of epidemiology which gave rise to the notion of an 'epidemic constitution' of the different years, a conception which was very fertile and stimulating to the great clinicians of the seventeenth and eighteenth centuries and is by no means without value even for the modern epidemiologist.
Further, as the attention of the post-mortem investigators at our large hospitals was directed to the subject, it was found that a very considerable percentage of all bodies, ranging from twenty to according to some estimates as high as sixty per cent, showed changes in the appendix and its neighborhood which were believed to be due to old inflammations; so that, while it is possible to speak only with great caution and reserve, the balance of opinion among clinicians and pathologists of wide experience and the more conservative surgeons appears to be that from one-half to two-thirds of all cases of appendicitis will recover of themselves, in the sense of subsiding more or less permanently, without causing death.
Apoplexy, diabetes, arteriosclerosis, Bright's disease, are met with almost exclusively in what the older clinicians talked about as the apopleptic type. On the other hand, they said, anemias, tuberculosis, hemophilias, scrofulas occurred more among the lymphatic type. But they had no idea whatever of the true functional basis of the two different types.
And some of our more enthusiastic clinicians of wide experience are actually introducing the open-air cure, which has worked such wonders in tuberculosis, in the treatment of pneumonia. In more than one of our New York hospitals now, particularly those devoted to the care of children, following the brilliant example of Dr.
If the child has had a rheumatic inflammation of the heart, or has had rheumatism without such a complication, it is considered by some clinicians wise to give a week's treatment with salicylates at intervals of three or four months, for two or three years, perhaps. It is hard to determine how much value this prophylactic treatment has.
The tablet should of course be dissolved or crushed with the teeth. It should not be given on an empty stomach, as it may cause considerable irritation and pain. It more or less actively lowers the blood pressure for about an hour. Erythrol tetranitrate is preferred by some clinicians who find that its effect lasts somewhat longer.
This pathetic type of face has that fatal gift which the French clinicians, with their usual happiness of phrase, term La beauté du diable. The eager eyes, dilated nostrils, parted lips, give that weird air of exaltation which, when it occurs, as it occasionally does in the dying, is interpreted as the result of glimpses into a spirit world.
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