« AnteriorContinua »
disease, had led him to remain a quiet spectator of nature; so in the latter case the opinion formed by the medical attendant of the nature of the complaint induced him to be very active; but active in the wrong direction, namely in endeavouring to draw the supposed lait repandu to one centre, or, in other words, in attempting to create a milky secretion where there was none, in which of course he was unsuccessful. These cases fell under my own notice.
I might adduce several others.
The medical practitioners in St. Petersburgh also differ from their brethren in other countries in regard to their nomenclature of diseases, (nosology.) In some respects they have adopted that of Pinel. They admit a variety of fevers as diseases of a peculiar kind, which in other countries are considered only as symptoms. The result of which is, that symptoms and not the real disease are treated. They acknowledge too the existence of a fiévre ataxique, (putrid fever) for example, not from foul stomach, congested liver, or unrelieved bowels; but from vitiated humours circulating through the body. Hence the treatment is entirely directed to the purification of such humours, and the other three indications are either overlooked, or considered as of secondary importance. From what I observed in hospitals, as well as in private practice, there is no great disposition to admit the immediate existence of active inflammation, and bleeding is, therefore, seldom resorted to at the onset of a disease. In visiting one of the Hospitals with Dr. Ruhl one day, we observed a young woman whose face was flushed and swollen, whose lips were blue and whose respiration was short and difficult. I felt her pulse; she was feverish; I made her draw in her breath; she could not do so without pain. She was labouring under inflammation of the chest. She had been three days in bed; no blood had been taken from her. Dr. Ruhl readily agreed with me that the physician ought to bleed the patient, and
being the superior officer, recommended it to be done while we visited the other parts of the establishment. We returned in an hour or so; the operation had been performed, the countenance of the young woman showed with what success; her attempt at taking a deep inspiration, with scarcely any pain, confirmed our conjecture respecting the improvement which had taken place since our former visit. The propriety of bleeding her had not, indeed, escaped the attention of the medical attendant; but he had written an order to that effect on the tablet for "cras," it being then noon!
The practice of medicine is again different, in respect to the choice and number of medical agents employed to combat disease. Powerful purgatives are seldom resorted to; mercurial alteratives are scarcely ever employed; feeble aperients on the one hand, and tonics on the other, and what are called nervous medicines, are mostly used. The medical practitioners in St. Petersburgh admit by far too large a catalogue of drugs, and consider many simple as well as compound chemical preparations to possess virtues which an English physician would not think consistent with experience. They will frequently recommend medicines which are inert, or rely upon the smallest doses of those which possess known properties. Sir James Wylie published an excellent and extensive pharmacopoeia for the use of the army medical officers. That gentleman has travelled too much, and read still more, not to know how much simpler than formerly is the manner of treating diseases in the rest of Europe, and particularly among his own countrymen, with whose medical works he is well acquainted. He is perfectly aware that the really useful part of a pharmacopoeia is but short and by no means complicated; yet fearful of the result of any attempt to bring about too sudden a reform in his department, he has allowed many articles to stand in his book which he will propably ex
punge as useless hereafter. The inspection of the medical supplies to be found in the "Aptekas," of the list of medicines ordered for the hospitals,-and of the drugs procured from this country (for most of them are sent for from England through a highly respectable mercantile agent) have convinced me of two facts. First, that many articles are used which no other medical men ever prescribe now; and secondly, that frequent changes take place in the selection of the principal articles ordered for importation, showing a correspondent change in the opinion of the virtues of certain drugs. Why, it might be asked, does not the city of St. Petersburgh, with professors of chemistry, and almost every mineral production as well as vegetable substance that can be required, easily procured from the interior of the Empire, supply itself with many of those chemical preparations which are now sent for from England? The general importation of medicines in Russia by private individuals, is subject to restrictive regulations and heavy duties; but admission of several of the articles, particularly artificial preparations and chemical substances, is encouraged. There can be no doubt, but that the same articles might be manufactured in Russia, if competent persons were employed for that purpose.
All these facts are readily explained. In the first place, the medical profession in St. Petersburgh includes every description of foreigners. There are, indeed, some Russian practitioners, but these are too few in comparison with the whole number. The rest are Germans, French, Italian, and English. Most of the Russian physicians, or surgeons, who are educated at the Medico-Chirurgical Academy, first go into the army, and seldom remain or settle in the metropolis. Each of the foreign physicians brings his own system of medicine along with him, on which he acts, with frequent deviations from the original, so that the collective result is a miscellaneous kind of practice. In
England, in France, in Italy, physicians doubtless differ in many points of doctrine and practice among themselves in each country; still the aggregate results constitute one uniform plan, which may, with propriety, be called national at St. Petersburgh such is not the case. Each medical man acts on individual and exclusive opinions, brought from different schools, and no uniform results are in consequence deduced. In the second place, the knowledge of the progress and improvements made in the art of recognising diseases, as well as of treating them, is tardy in reaching St. Petersburgh, and then only by indirect channels; and yet it is 'only by a ready and free communication of discoveries and useful observations made in both those departments of medical practice, in different parts of the civilized world, that we can hope to maintain ourselves on the level of medical superiority.
It will be seen, that in explaining the reasons of the difference which has appeared to me to exist between the practice of medicine in St. Petersburgh, and that of other countries, I have attributed nothing either to the want of able and respectable practitioners, or to insufficient medical education. I should have swerved from truth, had I insinuated either of those surmises. Among the physicians and surgeons who take the lead in St. Petersburgh, there are several of acknowledged merit, and others, who to that qualification unite the advantage of long personal experience. Unfortunately, most of those who belong to the latter class, are past the prime of life, or have worked their days" so hard and full," that the public may, perhaps, be deprived of their services at no distant period, and see them retire from active duties, while those to whom the former character is applicable, are so connected with important establishments, or with the several members of the Imperial Court, that they can scarcely be said
to form part of the general mass of practitioners. Sir James Wylie, for instance, whose experience both as a physician and surgeon, has been very extensive, and of the first order, cannot be said to be one of the medical practitioners of St. Petersburgh. His devotion to the late Emperor, from whom he was inseparable, and his unremitting attention to that public department which he has himself created and brought into a prosperous state, have cut him off from private practice. He is, in the first place, Principal Inspector of the Army Medical Service, and in the second, Director of the Medical Department, in the Ministry at War, as well as President of the Medico-Chirurgical Academy. These are no sinecure offices, and Sir James discharges his several duties conscientiously and indefatigably. He has, therefore, no time left for any other professional occupation. My other friend, Dr. Ruhl, first physician to her Majesty the Empressmother, has too much to attend to in carrying into effect the benevolent intentions of that princess, and inspecting daily the several institutions which are under her Majesty's immediate protection, to be able to devote any portion of his time to private patients. Dr. Rehmann, a gentleman, equally distinguished for his talents and for his many amiable qualities, is too much engaged with his official duties under the Minister of the Interior, as physician-in-chief for the regulation of the civil department of medicine all over the empire, ever to be able to take an active share in private practice, were he even in the enjoyment of much better health than he unfortunately possesses at present. Doctor Stoffregen, who attended the late Empress, and whose name stands high in the profession, is, I believe, quite indifferent as to private practice. A fourth German physician, Dr. Harder, who has had considerable experience in St. Petersburgh, and who is not young, has been recently appointed to an office at court, and has given up most of