Clinical lectures on diseases of the nervous system : delivered at the National Hospital for the Paralysed and Epileptic, London / by W.R. Gowers.

  • Gowers, W. R. (William Richard), 1845-1915.
Date:
1895
Catalogue details

Licence: Public Domain Mark

Credit: Clinical lectures on diseases of the nervous system : delivered at the National Hospital for the Paralysed and Epileptic, London / by W.R. Gowers. Source: Wellcome Collection.

Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.

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    ence plays a part which you can discern only by an effort, in a large part of diagnosis. You think you observe the presence of consolidation of the lung or of pleural effusion. You do nothing of the kind. You infer its existence from certain physical signs. I remember an incident which illus- trates the risk of error thus involved. A skilled physician gave orders to his house-physician that a surgeon should be called in to tap a chest, one side of which was full of fluid. When the surgeon came he took notice of the chest before plunging in his trocar, and, being a man of a thoroughly scientific mind and used to observation, he was struck by the fact that there was no enlargement of the chest. Although he was a surgeon, he percussed carefully, and found that every other sign of pleural effusion was present except enlargement of the side. He declined to tap. A little later the patient died, and the lung was found to be a solid mass of cancer. That was a case of incomplete observation, but it illustrates the fact that even a condition like pleural effusion, which you seem to observe, is really recognized by complex inference, and if either the process of reasoning or the observation is deficient, conclusion may be wrong. To return now to the case I mentioned. The patient is a man of forty-eight years. I saw him a few hours after he had been seized with hemiplegia, which had come on in a few minutes. Such a sudden onset means a vascular lesion, the rupture, or closure of an artery. The onset had occurred without any loss of consciousness and without prodromata. There was no sign of degeneration or of kidney disease. The ophthalmoscopic appearances were normal. The hemiplegia was complete; but the entire absence of any loss of consciousness made it distinctly unlikely to be hemorrhage; and the facts that there was no tension in the pulse, and that there was a perfectly nor- mal heart free from hypertrophy, made rupture of a vessel