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

Acute Inflammation around the Upper Cervical Vertebræ: A Subjective Clinical Study.

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