Inaugural Address on Medical Treatment
Authors: S. Wilks
Journal: BMJ (1885)

evolution, and in cases which, superficially regarded, are uncomplicated.But having great integration of medical knowledge of other kinds, he does not regard them as eye-diseases only, but finds what they mean, what wide symptomatology they are important elements of.By co-operation of many different workers, each with definite or special knowledg of particular kinds, and each with great integration of more general knowleuge, we may hope to thoroughly analyse three very complex symptoniatologies.The symptoms are slowly produced, are presented in detail, are persistent or permanent, and, so to speak, are comparatively simple analysing experiments by disease on the lowest level of evolution (simple dissolutions).But now regarding these symptoms taken en bloc as signs of negative lesions of (nearly) all parts on the lowcst level of evolution, let me compare and con- trast them with symptoms from negative lesions on the highest level.The condition of a patient after a severe epileptic fit is one of nearly universal, and almost total, paralysis (dissolution effected).He has loss of consciousness, but this has nothing to do with his not moving.The symptomatology is, so to speak, the "evolutionary sum" of all, or nearly all, the symptoms of all the diseases on tlhe lowest level of evolution.This statement needs obvious qualifications; one is important.Since the epileptic discharge, beginning in the highest centres, produces effects in nearly all (onto-and epi-) peripheral parts, currents from this primary discharge must have tra- versed and discharged more or less of the middle and lowest centres, in order to "get at" the periphery.Hence the paralytic condition after a very severe fit will be a very compound one, a very compound dis- solution, all orders ofcentres being somewhat exhausted, but in different degrees.Thus the neurologist, by availing himself of the different definite work which ophthalmic surgeons, aural surgeons, laryngologists, etc., are doing at different points all along the (1) lowest level of evolu- tion, by working himself at different diseases on the (2) middle level (epileptiform seizures, monoplegias, migraine, etc.), by working with the alienist physician at diseases of the (3) highest centres (epilepsies and insanities) may hope to justify his differentiation.The several workers may hope to add (1) different (2) definite knowledge to, and further the (3) integration of general medical knowledge, and to lead to a higher and more methodical (4) co-operation of different workers.I say once more that this wide comparative study cannot be methodic- ally undertaken, if we confuse psychology with the anatomy and phy- siology of the nervous system-not if we take the organ of mind to be mind.The "organ of mnind" is simply a series of centres re-re- representing impressions and movements of all, literally all, parts of the body.LACTIr ACID AND TUBERCULAR LARYNGITIS.-A discussion has taken place in the Berlin Medical Society on the value of lactic acid in laryngeal tuberculosis.Dr. Krause stated that, of fourteen un- doubted cases he had treated in this way, some were improved, and some completely cured.The least satisfactory cases were those where the posterior wall of the larynx was affected; also those where there was a lesion below the vocal cords which could not be well brought under the influence of the application.The voice improved, also the power of swallowing, and the general condition of the patients.Dr.Rosenberg confirmed the statements of Dr. Krause as to the good effects of lactic acid, but, for his own part, was still more satisfied with the results of a twenty per cent.solution of menthol.He was also treating pulmonary phthisis with menthol-inhalations.Dr. Lublinski had had a certain amount of success with lactic acid, but found that, after the ulcers had healed, they again broke out Pro- fessor Virchow pointed out that when these ulcerations healed, a cica- trix only was formed, not true mucous membrane.He hoped that further observations on this subject might be made, especially on cases that had healed for some time.