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Robert Hooke, in his suggestions for an improved plan of building London, may be said to have anticipated some important measures of sanitary reform. He obtained, through Cornelius Drebbel, the first microscope used in England, and in 1629 discovered the cellular structure of plants, applying to the separate cells the name of utriculi. It is remarkable how little additional knowledge of importance was attained in this direction until 1833, when Robert Brown, in his work on Orchideae, described the cytoblastema, or cell nucleus.
You will agree with me that Dr. Tillotson, the Archbishop of Canterbury, exercised a sound discretion in making Hooke, by patent, Doctor of Medicine.
This short account of the observations and intellectual character of Hooke will not be unseasonable, if it serve to impress you with the conviction, appreciating as we do the ingenuity of his suggestion of helps to auscultation of the living body, that the rules for physical investigation are not arbitrary and mystical, but distinctly deducible from scientific laws.
The credit fairly due to Hooke in no measure detracts from the merit of Laennec. That distinguished physician, with scarcely a hint to help him from previous observers, excepting a questionable statement of Hippocrates, that a sound like boiling water could be heard in the chests of patients with watery effusion, and also a general remark on the advantage of listening to the breathing, by Double, the author of " Semeiologie," produced in two short years of observation the first edition of his immortal work " On Diseases of the Chest," which constitutes the solid groundwork of our
6 VISIBLE SIGNS.
knowledge of thoracic diagnosis. Laennec, however, was fallible, and committed one important error; for being too much engrossed with the instruction derived through the ear, he disregarded the information obvious to the eye. To the great value of indications afforded by inspection, let me make it the object of this lecture to call your special attention. The two sides of the chest, when in a perfectly healthy condition, appear symmetrical in form, and similar in movement. A change in these respects, obvious to the practised eye, is usually induced by any serious disease of the lungs or pleura. Let me show you proofs of this statement by introducing to your notice four patients :—the first with a view to exhibit the movements of the chest, natural in character, notwithstanding the existence of constitutional symptoms otherwise tending to mislead; the second presenting a condition of chest produced by pleurisy and pneumonia; the third manifesting the characteristic movements attending phthisis ; and the fourth the peculiarities which, in this respect, characterize emphysema.
George S 1, the patient now before you, was sent
into this hospital, under the idea that "one lung was gone from consumption." But, although he had rapidly become thin, suffered from profuse night perspirations, and expectorated great quantities of "purulent matter," the aspect of the chest made me doubt the correctness of the opinion. You see that during inspiration the expansion on the two sides is equal, and that it is quite free even in the sub-clavicular regions. Your eye witnesses truly these important particulars.
This patient (George S 1), aged eighteen years,
is of phlegmatic temperament, and orderly habits, but obliged by his profession, that of a musician, to keep late hours. He was admitted November 5th, 1850. At the age of six, and several times subsequently, he is said to have had considerable enlargement in the region of the liver, which subsided, but seventeen months since recurred to an unusual extent, and did not yield to remedies. About eight months ago, he had violent attacks of cough, attended with expectoration of frothy yellow matter; in about three days the tumour subsided, but he still continued to expectorate, the expectoration containing pieces of skin which he compares to gooseberry husks. Five months ago, fresh exasperation of his cough occurred, with expectoration of "bags of humour the size of a chesnut. When the cough was tolerably easy these bags came up whole; when the cough was hard, they broke, their contents being first ejected, and their skins afterwards." He asserts that he could feel the bags come from the region of the liver. About two months since, fresh exasperation of his cough occurred, with imminent danger of suffocation. He says he felt a tearing sensation about the liver, as if something required to be ejected.
He soon began to throw up skins, and a piece of what he called gut, "about a foot long," and was obliged to tear these from his mouth to prevent suffocation. A week afterwards he had a fresh attack of cough with expectoration of matter like yellow jelly covered with blood. He then brought up several pieces of shrivelled reddish skin, each of which, when stretched out would have covered the fist. There was more blood mixed with them this time than before. For
8 HYDATIDS FROM THE LIVER.
three or four days after, he continued spitting up a reddish humour containing small fragments of skin. Five weeks ago, during a period of two days, he spat up a large quantity of black congealed blood. Three days previously, and two days subsequently to his admission, he expectorated a peculiar peach-coloured matter, which, when submitted to the microscope, was found to contain pus and mucous globules, but no echinococci. He has always eaten much vegetable food, and been particularly fond of cabbages; has never had jaundice. His father was asthmatical; one of his brothers died of phthisis; another brother died at the age of four years, three days after the bursting of a tumour, immediately below the ear, which in the course of a month had gradually acquired the dimensions of a goose's egg, and on bursting gave exit to a fluid resembling water. A fortnight before this child's death, a film formed over the sight of both eyes, and four days before his death he became "stone blind."
S 1, is five feet seven inches high, his weight nine
stones, four pounds and a half. He sleeps well, but still has nightly perspirations, and expectorates about an ounce and a half daily, more easily on stooping or lying down.
There can be little doubt that this case is one of hydatids of the liver, which have by absorption and ulceration found their way into the lungs, and been expectorated. Various circumstances, particularly the improvement in his strength and the absence of echinococci in the expectoration, may encourage the expectation of his perfect recovery. In the cases of hydatids which have come under my observation, I have generally ascertained one or more of the following circumstances,—hereditary liability, vegetable diet, or blows. This patient cannot recollect receiving any blow on the side. He has, however, taken much vegetable food, and the brother's history is remarkable in relation to hereditary tendency. Two inquiries present themselves in reference to the origin of these hydatid cases: first, What is the mode of introduction of the ova? secondly, Is there impaired vitality of some organ, rendering it apt to harbour these animalcules 1 The influence of moist food on sheep and rabbits, as increasing their liability to hydatids, is a matter of observation, and, from analogy, we should recommend in the human subject, when affected with these parasites, a nourishing animal diet. The promotion of the hepatic secretion is also desirable; the introduction of bile into acephalocysts seeming to be destructive to these parasites, and favourable to their
elimination. The treatment of S 1 has consisted
chiefly in a generous diet, the administration of tonics, with taraxacum, and the application to the hypochondriac region, of an ointment of iodide of potassium. His general strength is much improved, and the fulness in the hepatic region is subsiding.
The next patient whom I place before you has a very different aspect of chest. Even those of my audience who are at a distance can tell me at once, that the lower half of the right side of the chest is flattened, and scarcely moves in inspiration. You see also that the apex of the heart beats close to the left nipple, instead of its proper situation, namely, two inches below, and an inch within that part. You form a surmise