is going on in the system, I am sorry that I can give but
little positive information. The absence of urinary sediment,
&c. are of a negative character, and lead to no inference,
where other circumstances are wanting, as is most generally the
case. But if there be pain in the region of the kidney, and
other symptoms of gravel, without any appearance of sediment;
and if the urine be acid, and of the yellow tint above alluded
to, the stomach deranged, and an inflammatory diathesis, either
general or local (i.e. about the urinary organs), be present;
and if all these are associated with suppressed gout, or
tendency to cutaneous disease,--the existence of this form of
the disease may be suspected, and means immediately taken to
counteract it." p. 138.
We omit any analysis of the next chapter on the cystic oxide diathesis,
on account of the rare occurrence of this state of the system.
The next chapter of our author is on the phosphatic, or earthy
diathesis.
The phosphatic deposites are of two kinds; the _crystallized_,
consisting almost invariably of the triple phosphate of
magnesia-and-ammonia, and exhibiting the appearance of white, shining
crystals; and the _amorphous_, consisting always of a mixture of the
phosphate of lime, and the triple phosphate of magnesia-and-ammonia.
The causes apt to produce a deposition of the triple phosphate of
magnesia-and-ammonia, are thus enumerated by Dr. PROUT:
"Any thing acting generally, and producing _a nervous state of
the system_, such as the distressing passions, and particularly
_mental anxiety_ or _fear_, will frequently produce in many
people an excess of this salt in the urine. The same is also
true of many articles of food or medicine that produce a
hurried secretion of the urine, and act as diuretics; as the
neutral salts in some cases, and particularly the Rochelle
salts and other saline compounds, in which the acid is of
vegetable origin. So also, a long continued use of alkaline
remedies, or of mercury, in irritable habits more especially,
will likewise produce a tendency to an excess of this salt, as
well as of the phosphates in general, and even lead to an
actual deposition of them from the urine. The same sediment
also frequently abounds, or is easily induced, in the urine of
those who have long been in bad health, and in whom the
constitution may be considered as giving way, or, to use a
common expression, breaking up. In general, it is to be
understood, that the slighter causes affect only the
predisposed, and those in particular who are subject to other
diseases of the urinary organs or urine. It may be also
remarked, that children are more subject to this form of
deposition than adults; a circumstance, perhaps, to be referred
to the irritability of the system at this age, and the great
derangement of the digestive organs, to which they are
subject." p. 151.
The above mentioned causes are stated to be equally productive of
amorphous phosphatic sediments.
Our author next enumerates the very distressing symptoms, by which the
deposition of the earthy phosphates is attended. They consist in great
irritability; derangement of the chylopoietic viscera, evinced by
flatulency, nausea, obstinate costiveness, or peculiarly debilitating
diarrhoea; extremely unnatural stools, nearly black, or clay-coloured,
and sometimes resembling yest; pain, uneasiness, or weakness in the back
or loins; sallow, haggard expression of countenance; and finally, if the
disease be not arrested, great languor and depression of spirits,
coldness of the legs, and complete anaphrodisia, as occur in diabetes.
A curious and important fact has been stated in regard to the remote
causes, producing the phosphatic state of the urine. It has been
observed by Dr. PROUT, that a large proportion of cases of this
complaint may be traced _to some injury of the back_ from mechanical
violence, such as a fall from a horse, &c.
The remedies for this diseased state of the urine, found most successful
by Dr. PROUT, are,--opium, in from one to five grain doses, repeated two
or three times a day, until the unnatural irritability of the system is
relieved,--the same remedy in more moderate doses, in conjunction with
the mineral acids, cinchona, uva ursi, and the different preparations of
iron,--a large pitch, soap, or galbanum plaster to the loins,--and
setons or issues in the back, when the disease manifestly arises from
local injury. With respect to the bowels, Dr. PROUT remarks, that they
are very difficult to regulate. He has occasionally seen serious
consequences to arise from the exhibition of a small dose of calomel,
such as diarrhoea and debility, much aggravating the disease, and
endangering the life of the patient. For the regulation of the bowels,
small doses of castor oil, and laxative injections are most to be relied
on; while saline purgatives, more especially Rochelle salt and Seidlitz
powders, as containing vegetable and therefore destructible acid, must
be avoided.[24] Mercury, in all its forms, is also inadmissible.
"Alkaline remedies of every description, must be most carefully
avoided, their use in every point of view being most
mischievous when the phosphates are concerned. Indeed all
remedies that act as diuretics should, in general, be shunned,
and the patient should be prohibited from drinking too much.
With respect to drinks, in general, they should be of a
soothing, demulcent character, and prepared with distilled or
the softest water that can be procured; as hard waters are
literally poison in this form of disease."
The second division of the work under review treats of the mechanical
and organic diseases of the urinary organs. This portion of the subject
is handled with the same ability as the first. We regret, however, that
our space will not permit a further development of the author's views.
We trust, nevertheless, that we have imparted to our readers adequate
notions of the scope of the work, to render them sensible of its value
as a manual of urinary diseases. It is illustrated by a good coloured
plate, representing the principal varieties of urinary calculi.
The additions of Dr. COLHOUN consist of foot notes, and paragraphs
inserted in the text of the original work. We would not, however, wish
to be considered as approving of the course, for the most part pursued
by Dr. C., of inserting his amplifications in the text of the author,
merely distinguished by brackets. Besides the absence of sufficient
distinction between the matter of the author and commentator, the text
of the former is thus injuriously disjointed, and dependent sentences
sometimes widely separated.
In regard to the execution of the present edition, we regret to say that
it is wanting in typographical accuracy.
FOOTNOTES:
[23] The reader will bear in mind, that this acid is the same as the
uric, the name by which it is generally known.
[24] The reason of this exclusion of salts, containing a vegetable acid
is, that they become real alkalies in the course of assimilation by the
destruction of their acid, and therefore add alkaline properties to the
urine, already too alkaline.
MEDICAL LITERATURE.
ARTICLE XII.--RETROSPECTIVE REVIEW.--_Tractatus de Ventriculo et
Intestinis, cui proemittitur alius, de Partibus continentibus in
Genere, et in Specie de iis Abdominis._ _Authore_ FRANCISCO GLISSONIO,
&c. &c. Lond. 1677, 4to.
As it is not our intention to confine our remarks to the work above
mentioned, we shall deem no apology necessary for the somewhat excursive
nature of this article, which would not answer our present purpose, if
we were obliged to follow the costive details of the venerable FRANCIS
GLISSON, whose villanous bad style, and execrable latin, are only to be
excused or overlooked in consideration of the great importance of the
topics which he handles, and the profound reflections which he makes on
them. GLISSON is recognised as author of the physiological term
_Irritability_, and as the assertor of the inherent activity of matter.
HALLER says of him in his XIth book. "FRANCISCUS GLISSON, qui universis
elementis corporum, vim motricem tribuit, etiam nostram vim,
Irritabilitatem vocavit," &c.
He was a native of Dorsetshire, and was appointed professor of physic at
Oxford in 1627. This post he occupied during forty years, and is much
distinguished by his treatise de vita naturae, and by the work which
forms our caption. As he is the first who used the physiological term
irritability, we have thought that some researches on this subject in
general, and more particularly on his peculiar sentiments, might
profitably occupy our retrospective department; for it is very evident
that this subject is in general but vaguely discussed, both in medical
writings and conversation.
The ancient philosophers did not agree among themselves as to the nature
and origin of matter; some of them considering it as eternal in its
essence, and others as mutable and changeable in form. The theory of
atoms, published by DEMOCRITUS, and subsequently carried out so
elaborately by EPICURUS and his disciples, seems to have reached even
to our own times, with an increasing reputation and acceptance.
According to this theory, the kinds of matter, or elements, must he
regarded as infinitely various. HERACLITUS, who taught philosophy about
550 years before Christ, considered all things as derived from an
elemental heat or fire;[25] a philosophy which seems to us to have
formed the basis of the Hippocratic doctrines of life. Like HERACLITUS,
HIPPOCRATES tells us, that the calidum was the first principle of
things, and that by an expansion or extension of itself, it constitutes
all the objects of the material world. He expresses himself in the
following manner. That which we call warmth, or heat, seems to me to be
something immortal; something which comprehends all things, which sees
and knows all things, as well present as future. Thus assuming as a
basis, that the calidum is an almighty, all-wise being, or in other
words, a God, all in all, the cosmogony was developed as follows: Chaos
he regarded as that condition of the calidum, which preceded any
exertion of the Almighty faculties. In emerging from the chaotic state,
the greatest part of the heat having assumed the uppermost place, formed
the aether; another part having gained the lowermost place, constituted
earth; a third portion, midway between earth and aether, became air; and
a fourth part, establishing itself between the two latter, became water.
So that by means of the extension of this all-wise, elemental calidum,
we have the four elements, earth, air, fire, and water, out of which are
ultimately composed all the aggregates of the material world.[26] Now,
to apply this general principle to the formation of the living being
man, who seems to be a sort of microcosm in himself, we are told, that
that portion of heat which remained with earth, being expanded and
spread abroad in divers places, in some more, in others less, the earth
became dry, and something like membrane or pellicle was formed; the
matters contained in which, being heated as by a sort of putrefaction,
some parts became bone, some nerve, some veins and their contents, and
some formed the cavities and their contents, as the urinary bladder, for
example.[27]
The full exposition of the opinions of HIPPOCRATES was left for GALEN,
and we prefer to make reference to him on this theory, which by his
genius and talent was so much embellished, that it became the glory of
science, exercising an almost undisputed authority during a long lapse
of ages. Indeed the gigantic intellect of this great man, still
continues to shed its vast illumination over the world of science,
particularly that of medicine; which, if it owes its birth to the divine
old man of Cos, is not less indebted for its nurture and growth to the
celebrated native of Pergamus. GALEN is the facile princeps of
physicians. His astonishing industry, perseverance, and acquirements,
his ingenious arguments, and persuasive eloquence, give him an
unquestionable claim to the title of princeps, so long accorded to him;
and those who even in the present enlightened period, will study his
works, shall find themselves almost irresistibly led away by the charm
of his suasion.
GALIEN est le seul des anciens qui ait donne un corps complet de
medecine: Quoique forme des debris de toutes les doctrines precedentes,
son systeme offre cependant, malgre les contradictions ou il tombe assez
souvent, une unite remarquable dans toutes ses parties; un ensemble
seduisant, qu'un genie de l'ordre le plus eleve pouvoit seul imprimer a
un pareil edifice. Ramenant tout a un petit nombre de principes
generaux, qui s'ils ne peuvent satisfaire la raison, fournissent du
moins une reponse facile a tout, ce systeme dut etre adopte avec
empressement, et sa fortune ne peut etonner.--_Biographie Medicale, Tom.
IV._
GALEN may perhaps be justly regarded as an eclectic; but it is manifest,
that he mainly walked after the steps of his great predecessor, and
recognised model. The following passage seems to contain ideas not much
differing from those of HIPPOCRATES which we have presented above: "Who
is there, says he, that judging from the origin and constitution of
animated beings, doth not immediately infer the existence of a mind,
possessed of wonderful energies, extending to, and pervading every
portion of the universe! We every where perceive animals procreated,
which are possessed of the most admirable structure, and yet what
portion of the universe can be more ignoble than this earth of ours? Yet
a grand intelligence is seen to have reached even it from the celestial
bodies, which for their beauty are so astonishing, and which, as they
are for purity far more excellent than our earth, so they are the seats
of intelligences, far more pure and perfect than those which inhabit
these lower regions." He proceeds to remark, that animals, worthy of the
greatest admiration, are produced out of the slime and mud of ponds and
ditches, and even in putrefying vegetables, which, as they indicate the
miraculous properties of their author, also show us in what estimation
we should hold the higher orders of being. "We may even perceive a
rational nature in men, if we refer to such examples as PLATO,
ARISTOTLE, HIPPARCHUS, ARCHIMEDES, and many others. If, therefore, in
such a colluvies as the human body, (for by what better name can we
characterize a mixture of blood, bile, and phlegm,) a mind is formed of
such great and excellent faculties, what must we think of the excellence
of that which exists in the superior bodies?"
It may be said that GALEN expresses, in these passages, the Platonic
dogma of an _anima mundi_. But they certainly agree with the sentiments
of HIPPOCRATES; and whether he derived them from the former or the
latter, matters not, as both of them have invested matter with certain
qualities, which render it active, whether it be so essentially or by
the act of the Creator. GALEN may be also regarded as partially an
Epicurean; for he insists that there are several sorts of matter, or as
we should say, several elements; but he differs from that sect again in
affirming for it a passible quality. To show that there must be more
than one element, or kind of matter, he says, that if there was only one
element, or a unit, it would be impassible; it could undergo no change
whatever. For there would be nothing by which it could be made to suffer
any alteration, or into which it could be altered. Whatever is changed,
is changed into something else, and whatever suffers, suffers from
something extrinsic: therefore he affirms, that of necessity there must
be several sorts of matter, or elements. He says, "there are only two
theories on this subject deserving our attention; one of which affirms
that sentient bodies are composed of elements possessing the faculty,
(cum patiendi tum sentiendi,) both of suffering and perceiving an
alteration;" while the other affirms that such bodies are formed (ex
patibilibus, sed sensu expertibus) out of passible, but not sentient
elements. Neither of these doctrines does he consider tenable, so long
as only one element is affirmed, as earth, air, or fire alone, which
could never become capable of that great variety of actions we witness
in living bodies: but, admit several elements, and we suppose that the
mutual interchange of powers would yield a compound body, capable of all
the vital phenomena. Such, therefore, says he, as consider the human
body to be composed of fire, air, earth, and water, mutually transmuted,
alternated, and reduced to a given temperament, and thereby vested with
a sentient faculty, speak reasonably; and it is evident that there must
be more than one element, and that these elements are passible bodies.
PLATO had taught, that, though all bodies are formed of matter, yet
matter itself is not a body; and the same idea is conveyed by ARISTOTLE,
in the Lib. de partibus animal. & earum causis, II c.i. "Prima statui
potest ea quae ex primordiis conficitur, iis quae nonnulli elementa
appellant terram dico, aquam aerem & ignem: sed melius fortasse dici
potest ex virtutibus confici elementorum, iisque non omnibus sed ut ante
expositum est humiditus enim, & siccitas, & caliditas, and frigiditas,
materia sunt corporum compositorum."
GALEN also states, that in fire there exists a perfect heat and
dryness, in earth a perfect coldness and dryness, and so on of the rest
of the elements. For you cannot expect to find in nature a perfectly
simple and isolated element; because they are always mixed two or more
together. Hence the real terram, aquam, aerem, and ignem, become rather
a metaphysical abstraction, than a real entity. That is to say, matter
has no real existence, but is mere quality; for earth is not the mere
representation of dry or siccum; it is the representative of siccitas,
or dryness: fire is not the eidolon of calidum, but of caliditas; water
of humiditas, and air of frigiditas. Yet all these elements are in
nature possessed of more than one property. Fire is hot and dry, earth
is dry and cold, water is cold and moist, &c. If we refer, however, to
his account of the soul, we perceive at once, that these inseparable
qualities of the elements are the real active agents of life. He plainly
declares, that the soul is the mere result of organization, and perishes
with the structure in which it dwells. He thinks, "corporis temperiem
censendum est." As to the active powers of the four primary qualities,
he says, "At mihi quidem tam venae, quam reliquarum particularum singulae,
ob certam quandam temperiem quam ex quatuor sunt qualitatibus nactae, hoc
vel illo modo videntur agere."--De nat. fac. I.
It is plain he thinks, that the elements consist of a materia and
qualitas; but they are elemental by the _qualitas_ and not by the
_materia_.
After establishing that there are four elements, which are the common
and simple bases of all things, he goes on to show, that the proper
proportion and admixture of these, constitute the healthy state of
living bodies. If the calidum, for example, be unduly increased, the
body is destroyed; if it be improperly diminished by excess of the
frigidum, it will also perish. The business of the physician is to keep
the proportions just and harmonious; but, as no pure element exists
alone, the physician must employ the qualitas in conjunction with the
materia. These (to make a phrase) substantive qualities, are found in
medicines or food, which, like all objects of sense, are either cold,
hot, dry, or moist, and available of course in the management of a cold,
hot, dry, or moist derangement of the living body.
The elements of the human body exist in the four humours, blood, bile,
atrabilis and pituita; and these four humours correspond in quality
with the elements. Blood, which is the reservoir or continent of them
all, is a temperate humour. Bile, being the representative of calidum,
is hot and dry. Melancholy represents, in our microcosm, the element
earth or siccum, and is dry and cold. But pituita, which is moist and
cold, corresponds with the humidum element. Air exists in animals nearly
pure, as we learn from the phenomena of the pulse and of respiration. It
answers to frigidum.
He shows us in his lib. de naturalib. facultat. that, out of the
humours, all the parts are formed, and these parts are either _similar_
or _dissimilar_; i. e. simple or compound. Bone is a similar part, that
is, it is a simple part; so is an artery, or vein, or ligament. Each of
these is so constituted, as that it has a predominance of one element in
its nature; and it is therefore dry, or cold, or moist, &c. But if an
adust element be, by accident or disease, accumulated in a part
naturally cold, the function of such part is morbidly affected. The
natural tendency, however, of similar humours to unite, causes each part
to receive its regular supply; a principle which BICHAT has since
characterized as, _contractilite organique insensible_.
To show the wonderful simplicity of the Galenical system, which for
plainness and easy attainment may be compared with the improved
nomenclature of chemistry, we will cite a passage from ARGENTERIUS, who,
perhaps, was as learned in this kind of lore as any man of his time. In
his Tractatio de calidi significationibus, he says; "If any body would
undertake to give a general enumeration of those circumstances, in which
this term calidum and the others (frigidum, humidum, &c.) are applicable
to the explanation of this warmth, he shall find truly, that they are
the elements, the humours, the parts, the whole body, medicines, food,
air, climate, the weather, the season of the year, and even ages; for
these all are either temperate, or hot, or cold, or humid, or dry."
The animal body is moved and governed by two principles; one of them
corresponds to the _vie animale_ of BICHAT, and the other to the _vie
organique_. Since the power of sensation and of voluntary or elective
motion, says he, is a property of animals, and since that of growth and
nutrition is common both to animals and plants; the former may be called
attributes of the soul, and the latter attributes of nature. Whence we
say, that animals are governed by the soul and by nature, while plants
are governed by nature alone.
The powers of the body are faculties; and these are either natural,
vital, or animal: but they are so subdivided, that we have as many
faculties as there are sorts of action. Under the class of natural
faculties, we find three principal sorts; to wit, a facultas generatrix,
an auctrix, and a nutrix. But if you ask, says GALEN, how many faculties
there be, which result from the action of these on each other, you will
find them as numerous and diverse as there are numbers and diversities
of the animal parts. For example, we have an attractrix faculty, a
retentrix, alteratrix, expultrix, &c. &c., all of which are variously
modified, according to the nature of the similar or dissimilar parts
they are exercised in, or, in other words, according to the nature of
the tissues or organs, in which they reside.