The practice of medicine at St. George's Hospital forty years ago / [W. Howship Dickinson].

  • Dickinson, W. Howship (William Howship), 1832-1913.
Date:
1896]
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Licence: Public Domain Mark

Credit: The practice of medicine at St. George's Hospital forty years ago / [W. Howship Dickinson]. Source: Wellcome Collection.

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    2or> r'ARDIO-VASCULAR CHANGES OF RENAL DISEASE, whereas with the largtu . hlatation as well as parietal thickening. It looks as ir tne smaller vessels had some special cause of hypertrophy beyond that which affects the larger. There may be a special inhibitory mandate addressed to their muscular tissue, but against this we have to place the fact that the fibrous tissue, to which no such mandate could be held to apply, is at least equally thickened. Whatever be the cause of the hypertrophy, it must relate equally to both coats. In searching for the primary seat of obstruction, how¬ ever our attention may be arrested by the arterioles, we must not disregard the capillaries. These have been proved to be contractile, though they are not muscular.1 These vessels are in more intimate relation to the blood than any others, and may be supposed to be the first to be influenced by its abnormal conditions; and as evidence that they are so influenced we have the appearance of dropsy—or, in other words, of abnormal capillary transudation—at the outset of renal disease. This process is capillary and not arterial, and at least points to a morbid condition of which the capillaries, not the arterioles, are the seat. Arterial obstruction, indeed, must be prohibitive of dropsy by cut¬ ting off the blood from the vessels which are its source. These considerations appear to indicate that, whatever be part of the terminal arteries, the capillary system is the point of departure of the series of changes which have been described. Whether these terminal arteries have any special sympathy with the capillaries with which they are so immediately connected is a question which suggests it¬ self. Whatever be the explanation of the vascular changes upon which I have dwelt, it must include the fibrous thickening as well as the muscular. Without attempting to pursue these questions to the end I will content myself for the present with having demon¬ strated the fact that under renal disease, putting aside the Paper by Dr. Roy and Dr. Graham Brown on ‘ The Blood pressure and its Variations in the Arterioles, Capillaries, and smaller veins.’ (Journal of Physiology, 1870-80, Part 2, p. 323.) PltKlKlSOhJ, U). tjou/blu^. paw. WITH OBSERVATIONS ON THE LARGER ARTERIES. 201 pulmonary department to which the same rule probably applies, there occurs a hypertrophy of the cardio-arterial system which is universal from its origin to its termination, and comprises not only the ventricle and the arterioles, but affects also the intermediate arteries of every size. In conclusion, I have to thank Dr. Rolleston, Dr. Lee Dickinson, and Dr. Cyril Ogle for procuring the specimens of which I have made use. My especial thanks are due to Dr. Rolleston—and to a larger extent to Mr. Fenton—for cutting and mounting the sections. THE PRACTICE OF MEDICINE AT ST. GEORGE'S HOSPITAL FORTY YEARS AGO.1 It was my good fortune, between the years 1852 and 1854, to serve as clinical clerk under Drs. Wilson, Page, Bence Jones and Pitman respectively, added to which, Dr. Wilson and Dr. Page, on their retirement from the Hos¬ pital, presented to me, unasked, their entire colloations of clinical books. The notes were then kept in books, not on detached sheets as at present. With these at my command, together with the post-mortem books, I will try to present the practice of the time, avoiding, as a rule, any personal reference to the practitioner. As regards one series only, which belongs to an earlier period than that of which I shall chiefly speak, shall I identify the physician. Among the books which I received from Dr. Wilson is one which records the practice of ‘ the great Thomas Young,’ who was physician to the Hospital from 1811 to 1829. The volume, which relates to the years 1828 and 1829, was passed on to Dr. Wilson, together with Dr. Young’s hospital patients, on Dr. Wilson’s appointment. This book appears to me to have especial interest, as exhibiting the state of medical practice in the early part of the century, and as exercised by the most comprehensive genius and greatest man of science who ever held the office St. George's Hospital Ga-dlc. May and June. 1823.