BRISTOL
THE
flfoebico==CbituvQical Journal 1893.
MARCH,
acute
CERVICAL A
John
me
Kent
to the
There is
an
to take their
M.D.
Mineral Water
Lond.,
Hospital,
Bath.
a
disease
me."?Sir Thomas Browne,
old and own
upper
STUDY,
sick myself, if sometimes the malady of my patient be not M.D.
be
unto
scorn
Spender,
Royal
the
VERTEBRAE. CLINICAL
SUBJECTIVE
Physician
"Let
around
inflammation
ragged piece
medicines.
of wit which tells doctors
a glance which is a note of partake of what he so freely Every medical man ought (so it
With
is invited to
the
physician cheaply orders for others! has been said) to try a new drug upon himself before he tests its efficacy in a patient. I have done this often, but the experiand
ment has seldom
generally, the simple
so
made
devoid of
dulness of
me
wiser
or
better.
It has been,
physiological passion and interest, that the thing has deterred me from further
trials. The doctrine of medical self-sacrifice has risen to a much higher level. A transcendental view is that it is the function (in the of a healer to suffer himself as of well
language as
to
obedience Vol. XI.
cure
to
mathematics) suffering in others.
It is
a
mark of
try diseases upon ouvselvesto lie in
No. 39.
probationary philosophic calm
DR.
KENT
JOHN
SPENDER ON ACUTE INFLAMMATION
and watch the solemn order of our symptoms. Against his knowing that he has run into danger, a
will and without
may become deadly sick; he is suddenly in the midst of a severe battle, and cannot run away. Courage and even defiance he may show; but I recommend him a quiet sub-
physician
mission to his destiny. Heart and nerves are more likely to stand the ordeal when the temper is in a sedative mood. Let us keep our emotional forces still. Say to the unwelcome
guest?" Sit
down and do your mischief as quickly as you can 'r dwell in my poor tabernacle your allotted time; but spare me the havoc and the pain, if such be the will of God." The loftiest chord is struck
by
the great Norwich
physician,
the head of this paper. The man quoted who is in diagnostic darkness about a case is invited to make himself ill in the same way; and when the illness comes, he is whose words
at
are
to watch its cruel
journey through
his
He looks into
body.
own
his system, counts the throbs and thrills, and studies the pains of phantasmal nerves. If this purifying chastisement be not enough, then he should approach near enough to death to understand its pangs and terrors. Will anyone try Sir Thomas Browne's plan ? But if we faint and fail to reach such a romantic standard, we may at least acquiesce in more modest ideals.
If there be any clinical school in which learn, it is his own bed of sickness.
to live and can
the grammar and syntax of Disease be minor ailments Even Dr. Beale's
doctor
ought
Nowhere else
thoroughly (some of them enjoyed in an impresso
"
"
mastered.
a
are anything but "minor") may be thus sive manner, and "learnt by heart" by the dullest intellect. A clinical vivisection on these academic lines strengthens the texture of personal character, and adds to our store of working
knowledge. The subject
of my present paper is
illness which overtook
me
in the
a
sudden and serious
of 1891. The illness side to it. I was away from
summer
had, so to speak, only a physical home, and was, therefore, undistracted by the worry which Mind and comes from loss of patients and apathy of friends. conscience
prospect of
only tranquil, but buoyant refreshing holiday. Innocent plans
were a
not
with
the
had been
AROUND THE UPPER CERVICAL VERTEBRiE.
and among the charming things proposed to be done short stay at Dovedale, in Derbyshire; not for the predatory purpose of killing fish, but from the more benign desire of loitering about a bit of lovely scenery. In the neigh-
made,
was
a
bourhood of the dale stands
grand
a
old manorial farm,
met-
comfortable hostel for strangers. amorphosed It is dignified by the emblematic name of the Izaak Walton Hotel. Here my wife and I proposed to stay for a week or so?walking, driving, reading, playing chess, or any other recreative whim. For two or three days everything was sunshine. It did not seem necessary to apply to oneself the dark so as
Shaksperian themselves
to be now a
oracle that
"
to
wilful men, The
injuries
procure, Must be their schoolmasters."
that 1
consciously "wilful," nor did I know that I brought injuries" on myself by want of prudence or other folly. And yet I was ignorantly walking by the side was
not
"
they
For I
had any of a
crater all the time.
giant clinical lectures, such as those delivered by during the middle of this century, a solemn and donnish feature was the recitation of the Prodromata. Every disease has its dawn and rise; and this twilight stage is comIn the
days
of
Dr. Walshe
before an opera or an oratorio. Thus, its fever has every specific warning signs; and these are often so characteristic as to be a fixed element in the diagnosis. Now it is grand, even if not a suffer to prodroma; and the pleasant, parable
to the overture
warnings
which
came
to
of heart and dulness of
In
(?)
May
or
plain perception had me
June, 1891,
a
were
and loud, if hardness not overlooked them.
great number of minute yellow
minatory clause (b) Quasi-syncopal attacks; sometimes breathlessness; an instinctive placing of the hand over the (c) Polyuria, region of the heart as if to support it. and the specific 1006. Rapid below urine the of always gravity decomposition of the secretion, which was very pale. Add to
freckles appeared m
on
both
arms.
This is
a
the creed of Rheumatism.
2
1
King Lear, II. iv. 305-7. I had nearly forgotten the persistent tachycardia, which began in April. ?^r- E. Long Fox gives a vivid portraiture of the physiological riot which goes on in and around the heart when its rhythm is persistently disturbed. {Influence of the Sympathetic on Disease, pp. 74-6-)
DR.
these
KENT
JOHN
SPENDER ON ACUTE INFLAMMATION
subjective points the cases in practice;
canker and
care
of
some
long and
and the supreme insanity of letting months ten without the rest and recreation of a single pass nearly 1 in the "day country." During July there was sleeplessness ; anxious
and the tongue Thus the
was
fur.
covered
health, and had become
ripe
germs that might fly in its way. At last the day came (August release should have taken initial blunder. "
Do
not
and
blackish-yellow level of daily for any naughty ready
5th)
for release.
down
run
fuel
a
with
habitually
had
organism
a
to a low
But that
different form; and here was the say to a sore and weary man?
a
always
Go away, my dear fellow, as soon as you can; leave your work run to the sea or the mountains." Facile and cheap advice,
and
scarcely
worth the
counsel?"
fee.
sleep,
as
apply
means warm
point;
common
homely is the days; enjoy absolute take only simple fluid
More wise and or
three
will; and
you
This has the note of
food." doctor
Stay
rest and
quiet;
proffered
in bed for two
common
sense; but when does 2
to himself?
sense
the immersion of the
body
in
physiological
a
the rate of metabolism is reduced
air;
and if the nervous
a
A silent time in bed
system be guarded
bath
of
its lowest
to
from noise and
worry, the equilibrium of function is soon restored. We halted at Cheltenham for a few hours, and reached Dovedale two
days afternoon,
on
the
evening
Thursday, August 6th. The next strolling about; but on Saturday
of
spent in
were
when
coming
of the tortuous and beautiful
out
enclosure called par excellence Dovedale, 1
On
Sunday, June 14th, 1891, "Pleasure-grounds"
weather in the
I rambled
a
cool damp wind ble\V
during
of Stourton Park.
a
day
of
magnificent
At the entrance is afl
people?the High Cross, erected in tha' gratitude to Edward III. It is an elaborate piece of stonework, decorated with the statues of eight monarchs: King John, Henry III., Edward I., Edward III., Henry VI., Elizabeth, James I., and
object which must city about 1373, as
Charles I.
be dear to Bristol
a
mark of
The last four
were
added in 1633, when the cross
was
enlarged
painted and gilded. It was taken down in 1733, and shortly afterwards given by Dean Barton, whose brother was rector of Stourton, to Mr. Henr) and
Hoare, who re-erected it where it to
now
stands.
client about-to-be quotes Aristotle's words that it is " bettef die than disobey the doctor" (&fxeiv6v iari t