I shall not, on the present occasion, detain you with prefatory remarks;
but, as a fairer proof than any I can adduce, of the necessity of such
a course of lectures as I now propose, shall merely repeat to you, upon
this subject, the sentiments of one whom genius in the science and skill
in the art of medicine have elevated high in his profession, and whose
eloquence is not less admirable than his professional abilities.
“To ally anatomy,” says he, “more closely with surgery, to connect the
art more intimately with the science from which it flows, seems to me
a task as yet imperfectly accomplished, though of the very highest
importance.—Anatomy is not made interesting to the pupil as the basis
of our reasoning on disease, the rule of our prognostications, the sole
guide in operating: He is taught to know the parts and remember their
names, and then he is dismissed from the school; and of this school we
are all pupils, abandoned early in our career, left to learn, in the
hurry of practice, the very principles of the science!—The anatomy of
surgery differs widely from that taught in the schools.—Pathology, which
ought to unite science with art, is a sort of neutral ground betwixt the
two provinces of anatomy and surgery, little regarded on either hand.”
To obviate these important defects is the very object of the present
lectures.—I shall assiduously study to supply all of them; I shall, after
delivering a natural system of medical science in general, the tendency
of which is not to controvert one established fact, but by pointing out
their relations, to consolidate, to simplify and if possible to increase
the amount of our knowledge on all the subjects of medicine—I shall,
I say, after this, enter into all its details, point out the relative
situation of those parts which perpetually come under the care of the
surgeon, explain all the variety, of the applications of an original,
fundamental and universally applicable principle of surgical operation,
and endeavour to direct the student, while, with his own hand, he
performs each of these operations.
Public bodies, Gentlemen, as well as individuals, have too often opposed
the progress of science.... But, when have they been able to impede
it?—Never. The iron grasp of tyranny and the intrigues of malice are
alike innocuous to truth; the progress of science is irresistible and
triumphant.
On the present occasion, I feel it my duty to propose a new system, nor
do I expect very different treatment; for though the gun of the soldier
and the anathema of the priest be no longer connected, the malice of the
interested and the intrigues of party occupy their place: the former
were the measures of a barbarous; the last are those of a half-polished
age. Fortunately, however, far from being formed to fear opposition—I
court it.
* * * * *
The following sketch of a natural system of medical science is founded on
the strict basis of physiology, and is, I trust, calculated to place, in
a new and more interesting point of view, the beautiful relations which
subsist between the sciences of anatomy and physiology and the art of
medicine, as well as to lay the foundation of a more rational system of
medical science.
I do not, however, make this statement without a feeling of the utmost
deference to the labours of the celebrated Cullen and Brown—the authors
of the existing systems and of innumerable observations of the highest
value in medical science. Nothing less than the firmest conviction of
the truth and simplicity of the system I am about to propose, could have
induced me to deliver it.
First, however, I shall proceed to exhibit the present state of medical
science.
No system of the medical art can be just in its principles, and perfect
in its application, which does not consider the derangement of the
mechanical, vital, and intellectual functions _distinctly_, and trace
each disease to the operation of its cause in the derangement of that
particular function which was first produced, and which led to the
derangement of all the rest.
It has been the fate of all systems to be founded upon partial views of
the functions. The system of the celebrated Cullen, for example, was
founded merely upon the vital functions, and even upon a very limited
portion of them—the state of the capillary vessels. Considering its
extent, however, it was valuable.
The system of Brown, likewise, was similarly founded merely upon the
state of the intellectual or nervous functions. That system, therefore,
although worthy of consideration, is not founded upon a view of all
the animal functions, and consequently does not rationally account for
all their derangements in disease. The basis of its author’s discovery
was his mistaking the mere elasticity or reaction of matter for a
peculiar property of living bodies, which he termed excitability. For
excitability, when it seems to have been exhausted, is apparently
restored by still stronger stimuli, upon the very same principle that
greater pressure brings into action the remaining elasticity of a spring
which had already lost some portion of it.
But what is worse, Brown totally forgot that matter has other properties,
and that the constitution of animals admits of other derangements than
those affecting their elasticity or their excitability. Extension, for
instance, another property of matter, may be destroyed in the living
body, by fracture, rupture, &c.; and there evidently it is not excitement
that is first produced, or that is worthy either of the first or of the
greatest consideration. Brown’s doctrine, then, refers chiefly to the
state of the nervous functions. Its chief merit is, that it involves a
great portion of their pathology. It is because it does so, that men of
ingenuity have often embraced it; and it is in reality because it did not
do more—because it did not involve the pathology of the other two classes
of functions, that men of much observation opposed it; and that even
many of those men of genius who, throughout Europe, had adopted it, were
afterwards forced, they scarce knew why, to abandon it.
Certainly, in all diseases, the nervous functions must be affected; but
they may be affected through the vital or mechanical functions—by means,
for instance, of an aneurism or a fracture. A fracture or an aneurism,
however, have no existence as diseases under the Brownonian system. These
are whimsically, absurdly, termed stimuli; not diseases, but mere causes
of disease; and the attention of the physician is, upon the principles
of that hypothesis, ridiculously turned from the immediate disease to
others depending upon it, to the state of the nervous functions. And
for what purpose? Not, by their aid, as mere accessary and subordinate
considerations, which in this case they really are, to regulate the
disease of the mechanical or vital functions, from the very first the
most obvious, but in order to discover the very existence of any disease;
as if fracture or aneurism in themselves were not alarming diseases,
independently of their effects upon other parts of the system, as if the
injury done to the mechanical functions, to loco-motion, was less worthy
the name of disease than that done to the intellectual functions, to
nervous motion. Yet, in practice, the Brownonian, even supposing that
the nervous system were little or not at all affected, would instantly
abandon his hypothesis, and demonstrate its inapplicability, by recurring
to the injury of the mechanical functions, by setting the fractured limb,
or operating for the aneurism. In the first of these instances, indeed,
the primary disease, almost the only one worthy of consideration, is
the injury done to the mechanical functions, to loco-motion, which has
absolutely nothing to do with excitability or excitement.
It is not my view, however, intirely to exclude these systems, or to
depreciate their real value, but to show that they merely form portions
of a natural system. Still no system of the medical art can be perfect,
which does not consider the derangement of the mechanical, vital and
intellectual functions _distinctly_, and enable us to trace each disease
to the operation of its cause in the derangement of that particular
function, whether mechanical, vital, or intellectual, which was first
produced, and which led to the derangement of all the rest.
These opinions I may support by the observations of others. “Efforts
laborieux et multipliés,” says Pinel, “de Sauvages, Cullen, Sagar,
Vogel, Linné, Nietzki, Selle, Van-Denheuvell, &c. pour distribuer toutes
les maladies connues en classes, en ordres, en genres, en especes, à
l’exemple des botanistes, et toujours pour résultat une extrême surcharge
du tableau, une classification a bitraire et vaccillante, des affections
symptomatiques prises pour des maladies primitives, une multiplication
excessive, des unes et des autres par des complications sans nombre des
maladies, une sorte d’impossibilité avouée d’obtenir un ensemble régulier
qui ne porte que sur quelques points fondamentaux, et qui vienne se
placer sans efforts et sans confusion dans la memoire.”
I cannot better explain my opinion of the present state of medicine
than by using, respecting it, the language of Lord Bacon, which is, at
this moment, as applicable to it, as it was when first written. “We
see,” says he, “the weakness and credulity of men is such, as they will
often prefer a mountebank or witch, before a learned physician, and,
therefore, the poets were clear-sighted in discerning this extreme folly
when they made Æsculapius and Circe, brother and sister, both children
of the sun.—For, in all times, in the opinion of the multitude, witches,
and old women, and impostors have had a competition with physicians.
And, what followeth? Even this; that physicians say to themselves, as
Solomon expresseth it upon an higher occasion, If it befall to me as it
befalleth to the fools, why should I labour to be wise? And, therefore, I
cannot much blame physicians, that they use commonly to intend some other
art or practice which they study more than their own profession. For, you
shall have of them, antiquaries, poets, humanists, statesmen, merchants,
divines, and in every of these better seen than in their own profession;
and, no doubt, upon this ground, that they find that mediocrity and and
excellence in their art maketh no difference in profit or reputation
toward their fortune; for the weakness of patients and sweetness of life,
and nature of hope, maketh men depend upon physicians with all their
defects.”
But Lord Bacon has assigned an amply sufficient reason for these
circumstances. In another place, he says, “Medicine is a science which
hath been, as we have said, more professed than laboured, and yet more
laboured than advanced, this labour having been in my judgment, rather
in circle than in progression. For I find much iteration, but small
addition.” Now it is, in reality, this profession without labour, this
labour without advancement, so well expressed by Lord Bacon, this
iteration without addition, which is the real and sufficient cause
(overlooked by him) of the poets so properly making Æsculapius and Circe,
brother and sister, and of the world uniformly placing witches, old women
and impostors in competition with physicians. And again his lordship,
with equal justice, says, “in the inquiry of diseases, they do abandon
the cures of many, some as in their nature incurable, and others as past
the period of cure; so that Sylla and the triumvirs never proscribed so
many men to die, as they do by their ignorant edicts, whereof numbers do
escape with more difficulty, than they did in the Roman proscriptions.
Therefore I will not doubt to note as a deficience, that they inquire
not the perfect cures of many diseases, but, pronouncing them incurable,
do enact a law of neglect and exempt ignorance from discredit.”
It therefore becomes proper to ascend to the cause of the little success
which has hitherto attended medical investigation, and to attempt, by the
removal of that cause, to accelerate its progress, and, by increasing the
success, to increase the respectability of the art.
* * * * *
The grand cause which has hitherto retarded the progress of medicine, has
been the total want of a general principle, and this want has arisen from
the very low state of physiological theory.
It has ever appeared to me that a sufficient distinction has not been
made between diseases as affecting various functions, which to the most
superficial observer seem to be very different in their nature. It would
appear, at first sight, that, instead of almost uniformly applying
mental remedies to mental diseases, the physician not only does not
distinguish what stages and parts of the same disease are mechanical,
what vital and what intellectual, which must uniformly be the case where
all the functions are involved, but that he does clearly perceive such a
distinction at all to subsist in any form or combination of disease.
The physician has also failed to attend to a correct arrangement of the
various articles of the materia medica, which ought not to be considered
merely as stimulant, sedative, &c. but as in reality operating upon
different functions.
Besides these, there appear to be other subordinate objects of inquiry,
which he has hitherto, to a certain extent, overlooked; namely, that
medicines seem to be objectionable from the injury which they do
to those functions which are the vehicles of their operation, the
uncertainty also of their effects as influenced by association, the
uncertainty of their continuance as dependent on the same and other
causes, the difficulty of removing their bad effects, and the injury they
do to the intellectual functions in making man entirely the creature of
direct impression instead of reflection.