_A Dissertation on the Importance of Physical Signs in the Various
Diseases of the Abdomen and Thorax. By Robert W. Haxall, M.D. of
Richmond, Va. Boston: Perkins and Marvin._
The Boylston Medical Committee of Harvard University, having
propounded the question, “How far are the external means of exploring
the condition of the internal organs useful and important?” a gold
medal was, in consequence, awarded to this Dissertation on the
subject, by our townsman Dr. Haxall. Notwithstanding the modesty of
his motto, “_Je n'enseigne pas, Je raconte_,” he has here given
evidence, not to be misunderstood, of a far wider range of study, of
experience, of theoretical and practical knowledge, than that
attained, except in rare cases, by our medical men. He has evinced too
more than ordinary powers of analysis, and his Essay will command (oh,
rare occurrence in the generality of similar Essays!) the entire
respect of every well-educated man, as a literary composition in its
own peculiar character nearly faultless.
The Dissertation does not respond, in the fullest extent, to the
category proposed. The only available method of discussing the
question, “How far are the _external_ means of exploring the condition
of the internal organs useful and important?” is to show, as far as
possible, the deficiencies of _other_ means—to point out the
inconvenience and want of certainty attending a diagnosis deduced from
symptoms merely general or functional, and to demonstrate the
advantages, if any, of those signs (afforded by external examination)
which, in medical language, are alone denominated _physical_. But to
do all this would require a much larger treatise than the Committee
had in contemplation, and so far, it appears to us, they have been
over-hasty in proposing a query so illimitable. Our author (probably
thinking thus) has wisely confined himself to diseases occurring in
the common routine of practice, and here again only to such as affect
the cavities of the Abdomen and Thorax. The brain is not treated
of—for, except in a few strictly surgical instances, the unyielding
parietes of the skull will admit of no diagnosis deduced from their
examination.
In the discussion of the subject thus narrowed, Dr. Haxall has
commented upon the physical signs which (assisted as they always are
by functional symptoms) lead to the detection of the diseases of the
_liver_, the _spleen_, the _uterus_, the _ovary_, the _kidney_, the
_bladder_, the _stomach_, and the _intestines_—of _Typhoid or Typhus
Fever_—of _Inflammation of the Peritonæum_—of _Pleura_,
_Pleuro-pneumonia_, _Hydrothorax_, _Pneumothorax_, _Catarrh_,
_Emphysema_, _Asthma_, _Dilatation of the Bronchiæ_, _Pneumonia_,
_Pulmonary Apoplexy_, and _Phthisis_—of _Pericarditis_, _Hypertrophy
of the Heart_, _Dilatation_ of that organ, and lastly, of _Aneurism of
the Aorta_.
The most important and altogether the most original portion of the
Essay, is that relating to the fever called _Typhoid_. The pathology
of fever in general has been at all times a fruitful subject of
discussion. Solidists, humorists, and advocates of the idiopathic
doctrine, have each their disciples among the medical profession. Dr.
H. advocates no theory in especial, but in regard to typhus fever
agrees with M. Louis in supposing the true lesion of the disease to
reside in an organic alteration of the glands of Peyer. He denies
consequently that bilious fever, pneumonia, dysentery, or indeed any
other malady, assumes, at any stage, what can be properly called a
“typhoid” character, unless the word “typhoid” be regarded as
expressive of mere _debility_. The chief diagnostic signs he maintains
to be physical, but enters into a minute account of _all_ the symptoms
of the disorder. The Essay is embraced in a pamphlet, beautifully
printed, of 108 pages.