18 OCTOBER 1856, Page 17

LA.YCOCIC ON MEDICAL OBSERVATION AND RESEARCH. * Ciaancia. study is the

"finishing-touch" for the young practi- tioner. When books, lectures, and "the subject' have taught all that he can (or will) learn he is taken to the bedside and there sees the difference beaten theory and practice ; between the strongly marked symptoms, clearly defined. and sharply dis-

tinguish' ed in the written letter, and those same symptoms not

• Lectures on the Principles and Methods of Medical Observation and Research, for the Use of Advanced Students and Junior Practitioners. By Thomas Laycock, ProfessOr of the Practice of Medicine, and of Clinical Medicine, en the Crniversity of Ed,,, burgh. Published by Black. suite so marked in reality as in description and complicated by individual .peculiarities, as well as confused by mere concomi- tants. It is on his bedside skill that the success of the young medical man will mainly depend. A person with slight scien- tific knowledge who is acute in detecting or guessing at the signs of disease, prompt in treating them, and who seems to ex- hibit mastery in all he says and does, will better succeed in his treatment of cases than a man of extensive technical knowledge but a slow or timid east of mind ; and, what some will think more to the purpose, will better please the patient and his friends.

These lectures of Dr. Laycock, introductory to a course of clini- cal practice to the advanced students of the Edinburgh University, do not handle diseases or their treatment unless in a very general way, nor do they deal with particular cases. Their first ob- is to aid the young practitioner in his studies on the living pa- tient. The lecturer directs how to observe the symptoms of disease, to trace those symptoms up to their direct causes, that is, the peal disease, and finally to discover what is the source of that disease —as transmitted, acquired by intemperance, or other origin. The lectures, however, go further than the observation of disease with a view to the discovery of its nature, the methods of treating it, and the prognostication of its result. Dr. Laycock aims at forming the mind of the student to a more enlarged and philosophical mode of looking at life and its derangements. Besides expositions of the best methods of clinical examination, the objects to be attained, and the readiest modes of acquiring experience in medicine, the lec- turer fully warns the pupil against the various fallacies that beset his path, and lurk even in the most received terms and phrases. Travelling into a somewhat larger sphere than that of the every- day medical practitioner, Dr. 'Aycock discusses the numerical method of research in medicine, or in other words of statistics ; shows its use, and fixes its limits. He also describes a new mode or "analogical method of research" in connexion with physiology and medicine ; which we think, to speak shortly, consists in tracing phenomena to their original elements, so far as we can get towards the elements of anything. In all that relates to the practical part of the profession, Dr. Laycock appears to be a safe guide. He will be a very safe guide in the higher or more theoretical branches of his subject, if he be judiciously interpreted and not too implicitly or too literally followed. One lecture is devoted to the fallacious use of theories, and a passing exposition of the fallacies that lurk in terms ; as in this example, taken, however, from a chapter on another sub- ject.

"Take care that the foundations of your analogies be facts, and not general terms, or mere expressions of general facts. For example, patho- logical anatomists speak of fatty degeneration' or calcification.' The facts are, that fat, or the salts of lime, are deposited in tissues in which, under ordinary circumstances, they are not deposited. Degeneration and calcification indicate theoretically the processes by which these deposits take place. Those terms, therefore, do not express facts, only theories. 'Tu- berculous,' inflammatory,' and all similar terms belong to this category."

Inn rigorous sense the remark is true ; but all arts have their vo- cabularia, which express results to the initiated in a much shorter form than a statement of the facts could do ; all terms and indeed all words do something of the same kind : "fatty degeneration" implies to an instructed mind the facts which Dr. Laycock men- tions, coupled with, we suppose, the admitted conclusion, that in consequence of the abnormal deposit the tissues have become de- generate or unhealthy. There is not the least harm—on the con- trary, very much of good—in the student testing all the terms which Dr. Laycock mentions, or indeed any others, so as to see precisely the facts, conclusions, and hypotheses they contain, but without losing sight of the received meaning they convey. Habits of investigation cannot be too much cultivated, provided they do not degenerate into the habit of cavilling. Unless the recommendations of Dr. Laycock be adopted with judgment, they may lead to a mood. of mind that may be more disposed to argue than to act.

Although the lectures teem with warnings as to the difficulties of arriving at exact medical conclusions from the complications of the vital principle and the hidden. nature of the parts affected, we are not sure but that the author ranks medicine as a more exact science than we fear it yet is, whatever it may become. It was Sir William Knighton's opinion, that medicine (not surgery) had not advanced beyond what it was in the time of the Greeks. With the modern discoveries in chemistry, morbid anatomy, and the use of the microscope, this ought scarcely to be ; still some of Dr. Laycock's illustrations show that in many cases it is yet so. In this reference to the Father of Medicine the Doctor is indeed illustrating the difference between empirical observation and. scientific deduction; but practically it comes much to the same thing "What is requisite technically for a practitioner of medicine ? He may be considered from two points of view. First, as the uninstructed man, guided by an unenlightened experience. Secondly, as the taught man, guided by enlightened experience. The one knows disease and its treatment solely from having often seen similar groups of morbid phenomena or symptoms made to disappear by the same agent. Each symptom, or group of symptoms, he designates as a disease, giving it a name, said the agent he terms the remedy for the disease. All he asks for is a cure for the disease—it may be a headache or a cough—without reference to the abnormal changes in struc- ture and function upon which the abnormal phenomena depend. This is experience simply. From the earliest records of medical art to the present moment, we have abounding illustrations of this method of practice. Take as an example the Hippocratic treatment in a commencing case of pleuro- neumonia. When pain seizes the side, either at the conunencement or at a later stage, it will not be improper,' it is recorded in the works of Hippo- crates, 'to try to dissolve the pain by hot applications. Of hot applications, the most powerful is hot water in a bottle, or bladder, or in a brazen vessel, or in an earthen one ; but one must first apply something soft to the side to prevent pain. A soft large sponge squeezed out of hot water, and applied, forms a good application; but it should be covered over, for thus the heat will remain in the longer,' Fie. For the 2400 years which have elapsed since this was written, no more simple and at the same time equally effectual treatment of pleuritic pain has been discovered or practised; and it may be added, that to this day the modus operandi of the means has not been made out. Amongst the Hippocratic writings is the following as to the treatment of peri-pneumonio and pleuritic affections—' If the fever is acute, if there is pain in one aide of the chest, or in botli, if the patient suffers during expiration, if be coughs, if the sputa are rusty, or livid, or thin, and frothy, or blood-red, or if they differ in any way from healthy sputa, it is necessary to act as follows : The pain' extending upwards to- wards the clavicle, or towards the nipple and the arm, the inner vein of the arm of the affected side should be opened. The quantity of blood drawn should be in proportion to the constitution of the body, the season, the age, and the colour ; and if the pain is acute, the bleeding should be pushed boldly to faintness.' A plan of treatment not unlike the modern. These are illustrations of the simplest form of empirical therapeutics, or therapeu- tics.depenchnit upon the teachings of experience only."

In another ease, when death is approaching, modern science can discover the cause of the symptoms, but cannot ward off death any better than Hippocrates. Medical tact may be shown in the perception of the cause or causes of a given morbid state, and of the results ; in other words, of the antecedents and consequences. This knowledge was comprised by the ancients under the general term prognosis; by the moderns that term is limited to a per- ception of the event or consequences. As an illustration of empirical prog- nosis, I give the following from the aphorisms of Hippocrates : In a fever not of the intermittent type, if a lip, an eyebrow, an eye, or the nose be dis- torted; or if there be loss of sight or of hearing, and the patient be in a weak state—whatever of these symptoms occur, death is at hand.' Here again is a simple enumeration of phenomena in a given order, without reference to the cause or seat of the disease. The term fever comprising all its past as well as present phenomena ; the symptoms specially described are the prognostic phenomena, and death, the result, is predicted as necessarily following those symptoms. To the practitioner instructed in the physiology and pathology of the nervous system, such symptoms indicate a condition as well as a result, viz, a complication involving the base of the brain. Yet there is nothing to show that the writer of that ancient record of medical experience had such knowledge. We are sure, nevertheless, that with practised perceptive powers he must have possessed a quick insight into the course of disease, although his prognosis be purely empirical."

The moral of all this, and of very much more, is—cultivate medical perception ; which this book, judiciously used, will well enable you to do.