The most important diseases have their seat in the organs of the body;
an accurate acquaintance with their situation is, therefore, absolutely
necessary, in order to ascertain the seats of disease; but for the
reasons already assigned, their situation cannot be learnt, without the
study of anatomy. In several regions, organs the most different in
structure and function are placed close to each other. In what is termed
the epigastric region, for example, are situated the stomach, the liver,
the gall bladder, the first portion of the small intestine (the
duodenum) and a portion of the large intestine (the colon); each of
these organs is essentially different in structure and in use, and is
liable to distinct diseases. Diseases the most diversified, therefore
requiring the most opposite treatment, may exist in the same region of
the body; the discrimination of which is absolutely impossible, without
that knowledge which the study of anatomy alone can impart.
The seat of pain is often at a great distance from that of the affected
organ. In disease of the liver, pain is generally felt at the top of the
right shoulder. The right phrenic nerve sends a branch to the liver: the
third cervical nerve, from which the phrenic arises, distributes
numerous branches to the neighbourhood of the shoulder: thus is
established a nervous communication between the shoulder and the liver.
This is a fact which nothing but anatomy could teach, and affords the
explanation of a symptom which nothing but anatomy could give. The
knowledge of it would infallibly correct a mistake into which a person
who is ignorant of it would be sure to fall: in fact, persons ignorant
of it do constantly commit the error. We have known several instances in
which organic disease of the liver has been considered, and treated as
rheumatism of the shoulder. In each of these cases, disease in a most
important organ might have been allowed to steal on insidiously until it
became incurable: while a person, acquainted with anatomy, would have
detected it at once, and cured it without difficulty. Many cases have
occurred of persons who have been supposed to labour under disease of
the liver, and who have been treated accordingly: on examination after
death, the liver has been found perfectly healthy, but there has been
discovered extensive disease of the brain. Disease of the liver is often
mistaken for disease of the lungs: on the other hand, the lungs have
been found full of ulcers, when they were supposed to have been
perfectly sound, and when every symptom was referred to disease of the
liver. Persons are constantly attacked with convulsions--children
especially; convulsions are spasms: spasms, of course, are to be treated
by antispasmodics. This is the notion amongst people ignorant of
medicine: it is the notion amongst old medical men: it is the notion
amongst half-educated young ones. All this time these convulsions are
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