A valedictory address, on the art of examining the sick : delivered to the graduates of the Medical College of Ohio, on the first day of March, 1836 / by James Conquest Cross.

Cross, James Conquest

Date:: 1836

Credit: A valedictory address, on the art of examining the sick : delivered to the graduates of the Medical College of Ohio, on the first day of March, 1836 / by James Conquest Cross. Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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There are case9 of disease in which you will not be able to lay even signs and gestures under contribution, nor to obtain any assis- tance whatever from the patient himself or the knowledge of his friends. Such persons are usually found in a state of insensibility, and the physician will have to rely exclusively upon the accuracy of his acquaintance with the science of diagnosis, and the strength and acuteness of his powers of reasoning. The difficulties which such cases involve, will be more sensibly felt by an illustration. A stran- ger, for example, is found in his room a few hours after his arrival at a hotel, in a state of insensibility and unconsciousness. He is a man of robust frame, the trisplanchnic cavities are largely developed, and he appears to be about sixty years of age. His face is of a deep red or livid color; the temporal and carotid arteries pulsate with energy; the pulse is strong and hard; he foams at the mouth; respiration is embarrassed and stertovous; palsy has invaded one side of the body, and vomiting, together with involuntary dejections, have taken place. These are the data from which you are to reason, and I ask you what is the disease under which he labors? The most prominent feature of the case is unconsciousness. The inquiry of the physician should be, therefore, what are the diseases in which this phenomenon is ob- served? They are those of the heart, of the lungs, and of the brain. You now ask yourself,, is it one of those to which the heart is subject?: No; because the patient was in good health a few hours before he was discovered in, a state of insensibility, nor is there any derangement of the circulation, such as characterize affections of that organ. Is it syncope? No; for the face,, instead of being pale and exanguious,. is deeply flushed, while the pulse is strong and hard. Is it asphyxia? No; for although the respiratory and circu- latory functions are embarrassed, they still continue,, while the pa- tient has been exposed to the action of no eause capable of producing that disease. From this analysis, having discovered that the affec- tion under examination is seated neither in the heart or lungs,, you are convinced it must be one of those to which the brain is subject- Although you have now detected the organ affected,, you must recol- lect that the diseases of the brian are numerous. These have been, enumerated. Is it one of its chronic maladies? No;, for the patient was very recently in a state of sound health. Being acute> there- fore, you have now to determine which it is of the four or five of the acute diseases that attack the brain. Is it congestion? No; for that is a general disease and this is characterized by local phenome- na. Is it arachnitis? No; for that disease is also general while this has not pursued the course of that affection. It must, therefore, be either ramollissment or effusion* The former it cannot be; for though an acute disease, it never attacks so suddenly nor is its march so ra- pid as has been that under consideration. We, therefore, declare it to be cerebral hoemorrhage, and this opinion is sustained by ^the fact that, no other disease of the brain is so sudden in its attack. The seat and nature of the disease are now determined, but still the diagnosis is not sufficiently minute and precise. The patient is hemiplegic on the left side of the body; therefore the hoemorrhage occupies the right lobe of the brain. The hemiplegia is complete*

A valedictory address, on the art of examining the sick : delivered to the graduates of the Medical College of Ohio, on the first day of March, 1836 / by James Conquest Cross.

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