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+*** START OF THE PROJECT GUTENBERG EBOOK 78678 ***
+
+
+
+
+OUTLINE OF A NATURAL SYSTEM OF MEDICAL SCIENCE.
+
+
+
+
+                                  OUTLINE
+                                   OF A
+                              NATURAL SYSTEM
+                                    OF
+                             MEDICAL SCIENCE.
+
+                  FORMING THE PRELIMINARY LECTURES TO TWO
+                  COURSES: ONE ON ANATOMY AND PHYSIOLOGY;
+                      THE OTHER ON PATHOLOGY AND THE
+                           PRACTICE OF MEDICINE.
+
+                         BY ALEXANDER WALKER, ESQ.
+                       LECTURER ON PHYSIOLOGY, ETC.
+               EDITOR OF THE ARCHIVES OF UNIVERSAL SCIENCE,
+                                  &c. &c.
+
+    _By pronouncing diseases incurable, physicians have attempted
+    to enact a law of neglect, and to exempt ignorance from
+    discredit_.
+
+                                                         LORD BACON.
+
+                                EDINBURGH:
+                     PRINTED AT THE UNIVERSITY PRESS.
+              FOR SIR RICHARD PHILLIPS, NO. 6, BRIDGE-STREET,
+                         BLACKFRIARS, LONDON, AND
+                 MESSRS T. BRYCE AND CO. INFIRMARY-STREET,
+                                EDINBURGH.
+                                   1808.
+
+
+
+
+TO
+
+ALEXANDER MONRO, ESQ. SENIOR,
+
+_M. D. Professor of Medicine, Anatomy and Surgery, in the University of
+Edinburgh, &c._
+
+
+This Outline of a Natural System of Medical Science is most respectfully
+dedicated by one who is grateful for the benefits he has conferred upon
+Anatomy and Physiology, and who is desirous of following his footsteps in
+the cultivation of these Sciences.
+
+                                                         ALEXANDER WALKER.
+
+    _2, North College Street,
+        27th October 1808._
+
+
+
+
+ADVERTISEMENT.
+
+
+_In this small Work, the Author has delivered a very brief Outline of
+a Natural Systematic Arrangement and Theory of Anatomy, Physiology,
+Pathology and of the Materia Medica, as strictly dependent on each other._
+
+_Of this system the tendency is, not to controvert one established fact
+of Medical Science, but by pointing out their relations, to simplify, to
+consolidate and if possible to increase the amount of our knowledge in
+all the departments of Medicine._
+
+_As a work of this kind is a fair object of criticism; to the philosophic
+and liberal reviewer I have only to say, that I shall most willingly
+submit to his decision. Error is almost inseparable from propositions of
+any extent or magnitude, and I have doubtless committed many. But to the
+reviewers for the Edinburgh Medical and Surgical Journal, and those of a
+London Review under their influence, as they constitute a party somewhat
+in opposition to my views, I have to observe, that, should they act
+unjustly, as I know them not individually, I must hold their editor, whom
+I do know, responsible for their conduct, and I consequently shall do so._
+
+
+
+
+PRELIMINARY LECTURE TO THE COURSE OF ANATOMY AND PHYSIOLOGY; EXHIBITING
+THE OUTLINE OF A NATURAL SYSTEM OF THESE SCIENCES.
+
+
+GENTLEMEN,
+
+The functions of man are the most interesting objects of Science. Physics
+and Morals are equally involved by them. It is in them that the physical
+sciences terminate, and that the moral sciences have their origin.
+
+Of what avail are the former, but to develope the influence of external
+bodies upon the functions of man? What are the latter, but the results of
+the reaction of that influence upon men in society?
+
+To explain them is the business of physiology; and if it have hitherto
+failed in doing so—if it have even neglected the noblest of all the
+functions—I should say the noblest branch of philosophy—the intellectual
+functions of man, and have abandoned them to persons totally incapable of
+developing them, because totally ignorant of the structure on which they
+depend, and who have left them in a state of greater obscurity than that
+in which they found them, that is the fault of physiologists, and not of
+their science.
+
+In these lectures, I shall at least be influenced by the deepest sense of
+such errors.
+
+But it is not merely the philosophy of the human mind, or rather of
+the intellectual functions of man, that have thus been abandoned to
+barbarism. The science itself has never been systematized; and all its
+individual parts have been so neglected, that the other sciences and the
+arts dependent upon it, have been left in similar obscurity.
+
+I shall endeavour to shew that it is by the aid of physiology alone that,
+in explaining the functions of the eye, for instance, we can render
+perfect the theories of colour and of vision; that, in explaining the
+functions of the ear, we can construct rational ones of phonics and of
+hearing; that in explaining the functions of the organ of voice, we
+can illustrate the formation of letters, and the origin of languages;
+that, in explaining the functions of the muscles, we can establish those
+first principles of taste in the fine arts, the very existence of which
+have so often been questioned, and so deliver a theory of movement and
+of attitude, applicable to sculpture, the higher species of painting,
+gesture in oratory, &c. In fine, it is by physiological means only,
+that we can construct a natural theory of medicine, and render precise
+and easy, the most delicate and the most difficult of the operations of
+surgery.
+
+To effect these purposes, nothing is more necessary than arrangement,
+because it at once involves facts and their theory, or the reasonings
+founded upon them.
+
+       *       *       *       *       *
+
+In considering a natural arrangement of Anatomy and Physiology, it
+appears to me an unquestionable point, that it ought to indicate, at a
+single glance, the relation of all the functions to and their dependence
+upon each other.
+
+It is upon this principle that I have constructed the natural arrangement
+which I am about to detail; and a single remark upon the arrangements
+adopted by the most celebrated modern physiologists, will, at once, shew
+the originality of the plan which I propose, and point out the errors of
+arrangement which I deprecate.
+
+Blumenbach, Chausier, Dumas and Bichat, treat of circulation before
+absorption, on which it depends, and even before mastication, deglutition
+and digestion, on which, in general, even absorption itself chiefly
+depends.
+
+If the arrangement of Chausier in particular, who, in this respect, is as
+accurate as any of them, were to be considered as indicating the relation
+and dependence of the functions, so absurd is it, that absorption instead
+of the cause, would be the result of nutrition, generation the result of
+absorption, and digestion the result of generation. Thus, by arranging
+effects in the place of causes, they confound the relations of the
+functions, and reverse the very order of their dependence.
+
+The division of the functions into external and internal, as anciently
+proposed by Aristotle, and afterwards successively adopted and improved
+by Buffon, Grimaud and Bichat (the last of whom substituted for them the
+terms organic and animal) is still more faulty.
+
+Anatomy, I divide into three parts, namely that which considers the
+mechanical or loco-motive organs, that which considers the vital organs,
+and that which considers the intellectual organs.
+
+Under the mechanical or loco-motive organs, I class, first, the bones
+which support the rest of the animal structure; second, the ligaments
+which unite them; and third, the muscles which move them.
+
+Under the vital organs, I class, first, the organs of digestion, the
+absorbent surfaces, and the vessels which absorb from these surfaces;
+second, the heart, lungs and blood-vessels, which derive their contents
+(the blood) from the absorbed lymph; and third, the organs of secretion,
+which separate various matters from the blood. Then follow the generative
+organs, which, though generally formed into a distinct class from the
+vital, ought not by any means to be so reckoned. For it is evident, that
+they form, as it were, the sequel of the vital organs, being dependent
+on secretion—the last of the vital functions, and destined merely to
+propagate vitality, and to communicate it to a new series of beings.
+
+Under the intellectual organs, I class, first, the organs of sense, where
+impressions take place; second, the brain or organ of judgment, where
+these excite ideas; and third, the nerves, where volition results from
+the last.
+
+This is a natural arrangement of the anatomy of animals, and its peculiar
+simplicity is illustrated by its involving, in application, that of
+minerals and vegetables, and by its being capable of instant adaption to
+physiological science.
+
+In order to arrange Animal Physiology, it is only necessary to substitute
+the term “functions” for “organs;” and that science will likewise
+involve, in application, the physiology of mineral and vegetable bodies,
+and be, in its turn, capable of instant adaption to medical science.
+
+Thus, the functions also are divided into Mechanical, Vital and
+Intellectual.
+
+The mechanical functions are subdivided into that of support, that of
+connection, and that of loco-motion.
+
+The vital functions are divided into that of absorption, that of
+circulation, and that of secretion.
+
+The intellectual functions are divided into that of sensation, that of
+mental operation, and that of volition.
+
+A circle of functions, I may observe, thus exists in animals, which
+exists not in minerals or vegetables, because volition, the last of
+the intellectual functions, connects itself to the mechanical ones, by
+rendering them subservient to it in loco-motion. Thus the first and
+the last of these functions are as intimately connected as any of the
+intermediate ones, and a beautiful circle of organic function and organic
+influence is formed.
+
+The plan of the course will, therefore, be precisely the same with that
+which I have proposed for Anatomy and Physiology in general.
+
+I. In that part of the course which relates to the mechanical organs and
+functions, will be explained the structure and uses, _1st_, of the bones
+which support the rest of the animal machine; _2dly_, of the ligaments
+which unite it; and _3dly_, of the muscles which move it.
+
+II. In the first part of the course which relates to the vital organs and
+functions, will be explained the structure and uses, _1st_, of the organs
+of mastication, deglutition and digestion, of the absorbent surfaces,
+and of the vessels which absorb from these surfaces; _2dly_, of the
+heart, lungs and blood-vessels, which derive their contents, (the blood),
+from the absorbed lymph; and, _3dly_, of the organs of secretion, which
+separate various matters from the blood. Throughout this division in
+particular, the analogies from vegetables will be explained.
+
+III. In that part of the course which relates to the intellectual organs
+and functions, will be explained the structure and uses, _1st_, of the
+organs of sense which receive impressions from external objects; _2dly_,
+of the brain, where these impressions excite ideas; and, _3dly_, of the
+spinal marrow and nerves, where volition results from the last. In this
+division, will be also explained, as founded upon original observations,
+certain criteria of the various degrees of the sensitive, perceptive and
+voluntary powers possessed by different animals, as well as the nature of
+sensation, perception and volition themselves.
+
+As in physiological enquiries, comparative anatomy and comparative views
+alone can destroy an hypothesis or transmute it into a theory, I shall
+throughout the course introduce all its principal facts.
+
+The machines, says Cuvier, which are the object of our researches, cannot
+be demonstrated without being destroyed. We have no means of discovering
+what would result from the absence of one or several of their parts, and
+consequently we remain ignorant of the operation of each of these parts
+in producing the total effect.
+
+Fortunately, nature herself seems to have prepared for us the means of
+supplying that want which arises from the impossibility of making certain
+experiments on living bodies. The different classes of animals exhibit
+almost all the possible combinations of organs. We find them united, two
+and two, three and three, and in all proportions; while at the same time
+it may be said that there is no organ of which some class or some genus
+is not deprived. A careful examination of the effects which result from
+these unions and privations is therefore sufficient to enable us to form
+probable conclusions respecting the nature and the use of each organ, or
+form of organ.
+
+In the same manner, we may proceed to ascertain the use of the different
+parts of the same organ, and to discover those which are essential, and
+separate them from those which are only accessary. It is sufficient
+to trace the organ through all the classes which possess it, and to
+examine what parts constantly exist, and what change is produced in the
+respective functions of that organ, by the absence of those parts which
+are wanting in certain classes.
+
+Thus, says Richerand, the cellular structure of the lungs which cannot be
+clearly demonstrated in man, on account of the excessive tenuity of their
+smallest lobuli, evidently displays itself in the vesicular lungs of
+salamanders and frogs; in the same manner, the scales covering the bodies
+of fish and reptiles, or the claws of birds, give us a just idea of the
+structure of the epidermis, and of the disposition of its small laminæ
+that are laid over each other on a part of their surface, &c.
+
+Vegetable life, justly, says the same author, compared in its resources
+and effects with animal life, would throw very great light on several
+phenomena, which, at present, it is difficult for us to conceive and to
+explain.
+
+The medical treatment of vegetables, which is almost entirely surgical,
+would be equally benefited by these researches.
+
+Thus the wounds of vegetables, like those of the human body, are much
+less dangerous when their surface is smooth, than when their edges
+are rough, lacerated, or contused. Trees cut down with a saw bud with
+difficulty, whilst those felled with an axe vegetate more briskly.—The
+saw tears the vegetable structure and produces a greater or less
+alteration in organization. The unequal surface of a tree thus cut down
+retains humidity, as destructive to the trunk, of which it induces a
+rottenness, as too great a quantity of pus, that so habitually moistens
+the surface of an animal wound, destroys granulation and prevents
+cicatrization.
+
+In considering the application, or rather the relation of physiology to
+philosophy in general, the philosophy of mind will be particularly dwelt
+upon.
+
+In considering the application of physiology to the fine arts, the error
+in the construction of the antique statues, and of those of Michael
+Angelo, both with regard to the individual muscles supposed to be brought
+into action, and with regard to a hitherto unobserved principle of
+attitude, will be carefully pointed out.
+
+In considering the application of physiology to the medical and
+surgical arts, a view of a new, simple and impressive natural system
+of medical science in general, and of its first principles as an art,
+will be exhibited; and rules will also be given for performing surgical
+operations with the utmost precision and ease, upon the principle of
+an invariable relation between the arrangement of internal, and the
+situation of certain external parts, which consequently form accurate
+signs of that arrangement.
+
+       *       *       *       *       *
+
+I may now observe, that the series of beings which the arrangement I have
+just delivered involves, all more or less evidence the phenomena of life
+and intellect, as well as exhibit structure, and I may conclude with a
+few observations concerning these phenomena.
+
+Minerals have properly been said to exist, plants to exist and live,
+animals to exist, live and think.
+
+These are all modifications of each other, as I shall afterwards shew;
+but, at present, I shall limit my observations to the two last of these
+classes, and to the additional phenomena, namely those of life and
+intellect, which they more strikingly exhibit.
+
+I shall not, however, like some of the most celebrated modern
+physiologists, occupy my preliminary lectures with long details
+concerning their nature; but, as I reckon life to be the mere result of
+organization, I shall, throughout the course, illustrate it in connexion
+with those organs on which it depends, and shall, at present, only take a
+general view of its nature.
+
+Life is a term which some philosophers have hitherto inaccurately
+employed as expressing an imaginary principle, though it merely
+designates a series of dependent actions. This they were doubtless
+induced to do by that artifice which has ever induced weak men to assume
+an air of knowledge by giving a particular name to what they did not
+understand; and the same artifice still induces such persons to blame
+those who endeavour to explain the phenomena of life according to obvious
+physical laws, precisely because a successful explanation would at once
+exhibit their ignorance and their desire to conceal it.
+
+Life has, with equal absurdity, been termed a forced state, though it
+merely evinces a series of phenomena in justest unison with those of the
+universe. I dissent, therefore, from those who assert, that we employ the
+terms _life_ and _vital force_ to express what are apparent exceptions to
+general laws. This is only a repetition of the error of Brown. It was,
+however, an erroneous conclusion from accurate observations.
+
+For example, says Cuvier, let us contemplate a female in the prime of
+youth and health,—that elegant voluptuous form—that graceful flexibility
+of motion—that gentle warmth—those cheeks crimsoned with the roses of
+delight—those brilliant eyes, darting rays of love, or sparkling with the
+fire of genius—that countenance enlivened by sallies of wit, or animated
+by the glow of passion, seem all united to form a most fascinating being.
+A moment is sufficient to destroy this illusion. Motion and sense often
+cease without any apparent cause; the body loses its heat; the muscles
+become flat; and the angular prominences of the bones appear; the lustre
+of the eye is gone; the cheeks and lips are livid.... These, however,
+are but preludes of change still more horrible. The flesh becomes
+successively blue, green and black. It attracts humidity; and while one
+portion evaporates in infectious emanations, another dissolves into a
+putrid sanies, which is also speedily dissipated. In a word, after a
+few short days, there remains only a small number of earthy and saline
+principles. The other elements are dispersed in air and in water to enter
+again into new combinations.
+
+This, Cuvier adduces as a proof that the possession of life prevents the
+operation of external physical causes. The picture is perfectly correct,
+but the conclusion unauthorised.
+
+It was indeed impossible for us not to feel the frequent necessity of
+deploring those we loved. We therefore thought that we perceived this
+principle operating when the evident influence of external causes, or
+some mysterious agency seemed to drive the noblest results of life,
+intellect and genius, from the philosopher and statesman, who had, by
+the diffusion of truth and resistance to arbitrary power, preserved
+the liberties, and aggrandized the happiness of nations; we thought we
+perceived their influence when imagination’s powers fled from the poet
+whose song had once almost conferred new life on the heroes of ancient
+times; we thought we perceived their influence when the phenomena of
+vital action disappeared in the body of the patriot hero in whom they
+had once developed the noblest specimen of that generous love of social
+life which induced him to devote his existence to his country’s weal; we
+thought we perceived their influence when those magic charms abandoned
+the lovely female whose powers had once excited from the philosopher
+those splendid epithets that ranked her with the other objects of his
+adoration, celestial truth and god-like genius—which had obtained even
+from the poet those wonderful strains that at once immortalized him and
+the object of his song—which had commanded, even in the hero, those
+glorious devotions which, for far too short a period, illustrated the
+ever memorable days of chivalry. When those eyes whose soft languor had
+fascinated every beholder, those cheeks where life had often spread the
+crimson veil of love—when these were gone, those eyes were dim and sunk,
+those cheeks were pale, those lips were livid, that bosom depressed,
+that form rigid and icy cold, when all had thus assumed the darkest
+and most frightful hues, had gradually lost cohesion and become one
+mass of horrible putrescence, whose infectious effluvia now threatened
+destruction almost welcome to those who once adored the animated being—it
+was scarcely possible to feel all this, and avoid the conclusion that
+life was a state of force.
+
+It was doubtless this unknown and imaginary power connecting the various
+phenomena of organic structure that gave origin to the idea of life. But
+that they are no state of force is proved by this, that while the only
+notion we have of them is motion—successive attraction and repulsion,
+electricity, fire &c. exhibit precisely corresponding phenomena, and the
+last of these was, I believe, on that single account, considered as the
+symbol of life and intellect by the great Zoroaster.
+
+This and similar facts, I may remark, convince me, that the earth has
+myriads of times been illumed by the highest attainments of intellect,
+and as often plunged into darkness. This single point of Indian
+philosophy was, in my opinion, but the mere shadow of the highest
+excellence in philosophy in general; and as the greatest cultivation of
+the human mind, and the greatest misapplication of its faculties, cannot
+well exist together, I am equally convinced, that the beautiful specimens
+of art, blended with heterogeneous absurdities, in the monuments of
+Upper Egypt, afford the most striking proof that, contrary to the common
+assertion, there _were_ periods in that country when tyrants held no
+despotic sway over the physical, nor the priests of a false religion over
+the moral structure of man.
+
+But to return to the subject.—True it is that the affinities of external
+agents with the molecules of organic bodies are precisely the same during
+life when their influence is resisted as after death when it operates
+with the greatest energy; but the power which during life organic bodies
+possess of resisting the influence of external agents, and even the
+extension of the sphere of their action beyond the mere bounds of the
+living body, is, in my opinion, very easily accounted for.
+
+All the particles of matter possess attraction and repulsion, and the
+largest homogeneous masses, _coeteris paribus_, evidence them most.
+Hence, organic bodies, while they possess homogeneity by the subsistence
+of intimate relations between their parts, evidence attraction and
+repulsion in the highest degree. While in infancy, these relations are
+merely forming, the powers of attraction and repulsion are weak; when,
+in the vigour of life, these relations are most intimate, these powers
+are greatest; when, in old age, these relations are interrupted, these
+powers are also diminished; and when, in death, these relations cease
+to exist between the molecules, or in other words, when the body is no
+longer organized, the power of combined resistance terminates.
+
+Thus, life is no forced state, but an intrinsic power arising merely from
+the intimate relation of these molecules, and the greater effects which,
+in such combinations, they are capable of producing, than when, in death,
+they have become independent of each other, and their powers disunited,
+are capable of much less effectual resistance.
+
+Thus, it is, that I would endeavour to shew a connexion between the
+phenomena of living bodies, and the general laws of nature.
+
+This general and common motion of all the parts, says even Cuvier, forms
+so peculiarly the essence of life, that the parts which are separated
+from a living body soon die, because they possess no motion of their own,
+and only participate in the general motion produced by their union. Thus,
+according to the beautiful expression of Kant, the mode of existence of
+each part of inanimate bodies belongs to itself; but, in living bodies,
+it resides in the whole.
+
+When, I say, that life consists in motion, I make no assertion derogatory
+to the Deity, for every philosopher is of opinion that motion is to us
+as mysterious as life; and when I endeavour to trace in its phenomena
+a correspondence with physical laws, I conceive that I pay the truest
+homage to a Deity. At all events, it would be dishonest of me to give my
+sanction to opinions respecting a difference which seems to me not to
+subsist.
+
+The same causes which terminate motion terminate life. Life begins
+by motion, and terminates when it ceases; but very curiously it also
+terminates in consequence of it. In other words, the motion wears out
+the machine in which it takes place. For, while the functions are most
+dependent, life encreases; and their very independence, though, to a
+certain extent, the grand aim of existence, destroys it. The very cause
+of decay commencing when the different functions have acquired their
+greatest vigour, arises precisely from their having acquired that vigour,
+and being, at that moment, most capable of a species of warfare, if I
+may so term it, with each other, as well, as in some measure, from the
+greater number of accidents to which a complexity of functions is liable.
+
+That, at this period, the functions may, in a certain sense, be said
+to combat each other, will be evident to every one who, for a moment,
+considers that great exercise of the loco-motive functions uniformly
+interrupts the vital and intellectual, or of the vital functions injures
+the loco-motive and intellectual, or of the intellectual functions
+injures the loco-motive and vital.
+
+These powers are always in an inverse relation to each other.
+
+Grimaud seems to have had some idea of this, with regard to the first
+and second classes of functions. He, says Richerand, has given the most
+extensive developement to the idea of the constant opposition between
+those two series of actions, over which preside, according to the opinion
+of this physician, two powers, which he calls loco-motive and digestive.
+It is marked in no species of animals more than in the carnivorous,
+which connect with senses abounding in stratagem, and muscles capable of
+extraordinary action, an assimilating power of so low a degree, that
+their aliment, in order to be conveniently digested, must posses a
+composition analogous to that of their organs.
+
+Thus, the independence which the functions acquire, and the interruptions
+which their operations present to each other, subjects them to the common
+laws of impeded motion, and its result, a separation of parts.
+
+When, in manhood, their unison is most complete, life is most vigorous.
+When, in old age, this unison ceases, life disappears. Hence also, I
+am convinced, it is, that those animals whose functions are longest
+dependent on each other, and who remain longest helpless, longest enjoy
+organic existence.
+
+As motion only can result from motion, so life can only result from
+life. The vital actions of all animals originate in those of their
+parents, from whom they are detached precisely when their actions
+become sufficiently independent of them. I am convinced it is upon this
+principle, that the egg is detached from the ovary and the fœtus from
+the uterus, as well as because, in these cases, the ovary and the uterus
+themselves, after long quiescence, recover an independent action of their
+own. The same power which enables an organic body to act by itself,
+forces it to separate from another.
+
+Life then seems, in a great measure, to consist in the successive
+attraction and repulsion of particles—properties equally common to
+minerals, vegetables and animals, though in different manners and
+degrees. Life, however, is not here to be confounded with sensibility,
+which nevertheless I shall afterwards shew is also possessed by all of
+them. Life seems inseparable from generation, nutrition and decay, or,
+in other words, from origin, increase, diminution—a progression which
+minerals and vegetables pass through as well as animals. Minerals also
+increase by additions to their external surfaces, vegetables by absorbing
+from without inward, and animals by absorbing from their internal as well
+as external surfaces.
+
+       *       *       *       *       *
+
+By the intellectual functions, I understand the actions of the
+intellectual organs, or, in other words, those actions which constitute
+mind. With soul—the sacred and revered province of theologians, I do
+not wish in the slightest degree to interfere; not for the harsh reason
+assigned by atheists, namely, that the whole empire of ignorance, the
+direction of the basest passions, and the gun or bayonet of the soldier
+are under their command (these are sentiments which I never shall
+profess), but for a juster and a better reason, namely this, that soul
+is, in truth, their proper province.
+
+Sensation, then, seems to be entirely dependent on touch, which, in the
+other senses, is only modified so that one receives one kind of it, and
+another receives another; thus the tongue is touched by means of liquids,
+the nose by means of odours, the ear by aeriform vibrations, and the eye
+by light.
+
+All the other intellectual functions are nevertheless mere modifications
+of sensation. Upon them, therefore, we shall not dwell, but, by taking
+into view some important facts in anatomy, which have a relation to all
+of them, I shall be able to explain sensation in particular.
+
+Sommering has observed, that man has the largest brain in proportion to
+the nerves given off from it; and that this proportional magnitude, may,
+in every instance, be referred to as the best criterion of the degrees of
+intelligence. Now, it appears to me not at all difficult to account for
+this fact (the general truth of which may be granted), by comparing it
+with another not less important, viz. that, in the inferior classes of
+animals, the nervous system becomes, as you descend, more and more widely
+diffused.
+
+Hence, I deduce this important principle, viz. that the degrees of
+intellect are, in all animals, in exact proportion to the concentration
+of the nervous system.
+
+Now, the more equally distributed this system is, the more independent
+of each other are the parts of organized beings, or, in other words, the
+necessity of a connection of these parts increases, in proportion to
+the magnitude of the common trunk compared with the rami. It is only,
+therefore, in the more perfect animals, that the connection of the
+different parts of the nervous system, and particularly the presence of
+central parts, is necessary to the existence of the different functions.
+
+Animals, on the contrary, having this sensitive substance very generally
+diffused, when mutilated, recover their figure, or, when cut into pieces,
+form several individuals, having each a system of sensation and volition.
+The larger warm-blooded animals acquire pieces of flesh analogous to
+those which have been cut away; crabs acquire new claws; the tadpoles of
+frogs and water newts acquire new limbs and tails; and the lower end of
+the snail, having been divided from the upper, acquires a new head. The
+earth and boatworm, when divided into considerable pieces, form several
+new individuals; but animals having this system still more generally
+diffused, as the polypus, when divided into the smallest fragments, each
+fragment self-exists and becomes a perfect individual.
+
+This also is more or less the case with plants. As you descend among
+them, their parts become less dependent on each other. The dicotyledons,
+which possess irritability, sleep and the principle of life most
+diffused, and which, among plants, are analogous to the dicordated
+animals, namely quadrupeds and birds, possess concentric fibres and
+the most diffused sensibility; the monocotyledons, analogous to the
+monocordated animals, namely reptiles and fishes, possess more numerous
+centers and less diffused sensibility; and the acotyledons, analogous to
+the acordated animals, possess most numerous centers and least diffused
+sensibility.
+
+As, in some worms and zoophytes, there is indeed no appearance of nerves,
+and certainly none in plants, which yet possess sensibility, all this
+gradually approaches to the attraction and repulsion of the magnet and
+electrics, which, like some of these, are divisible almost to infinity,
+and yet possess their various powers, which, like the sensibility of the
+superior animals, connected by nerves, are only evidenced when led by
+conductors.
+
+Hence, I conclude, that sensation, understood in this limited sense,
+as distinct from perception, and differing, _toto coelo_, from soul,
+is, like extension, an imprescriptible property of all matter: but it
+may exist in as many forms and as many relations as it; in its separate
+particles; in larger combinations, as polypes; in still larger ones, as
+worms and insects, where these extended and sentient particles, connected
+by nerves, have more extensive relations and more complete dependence on
+each other; or uniting to constitute perception in whole bodies, as in
+the more perfect animals, where a sensorium commune exists, and where, in
+consequence of the most exquisite arrangement, and the finest relations,
+no particle can be deranged without affecting all the rest.
+
+It is indeed, these various degrees in which it appears, that afford
+a strictly analogical proof of its existence as a primary property of
+matter.
+
+As man then has not only sensation in the separate parts, but perception
+arising from the whole, the descent is gradual to beings which have
+merely sensation in distinct parts, but no general perception; and
+thence equally gradual to beings which have sensation limited to their
+individual particles.
+
+Now, as the perceptions of two of the superior animals cannot unite to
+form one perception, so the sensations of two parts of a polyp cannot
+combine in perception; nor is it of course more wonderful, that the
+sensations of two of the minute particles of matter cannot unite in one
+common sensation.
+
+As we do not expect electricity to be evidenced without conductors, why
+should we expect sensation, in any great degree, without those nerves
+which are its conductors? It would be as irrational to deny the former,
+when conductors are not present, as to deny the latter (understood as I
+have defined it), when nerves are absent.
+
+Neither is it more wonderful that these sensations, thus limited, are not
+evidenced; because it is scarcely to be expected, that the functions of
+that should be evident, the absolute structure of which is unknown, and
+because it is exactly in proportion to the concentration of sensation
+(and by no means to its division) that it is, at any time, evidenced.
+
+Upon the same principle, it is, that the particles of a pigment, when in
+contact, are more evident than when extended over an immense surface,
+or that a combination of pullies and one cord produce more evident
+motion than each of them, with separate cords, could separately. But it
+is unnecessary to accumulate illustrations—the principle pervades all
+nature, and every natural operation illustrates it.
+
+Nor do we merely find evident sensibility thus produced by the various
+arrangements of matter: it is implicitly dependent on all the changes of
+bodies, and is identified with their motions, by being suspended whenever
+these are suspended. Of this, the hybernation of animals, the winter
+state of most plants, the state of the embryo in utero or in ovo, of the
+chrysalids of insects, the nymphs of worms, and the seeds of plants,
+afford examples.
+
+Nor is this all: but evident sensibility may be produced and destroyed at
+pleasure by a mere alteration in the arrangement of the particles of one
+and the same body; as in the wheel animal, and the anguillæ of tiles.
+
+Nor is even this all: you may, if you choose, by the mere arrangement
+of the particles of matter, as I shall afterwards prove by experiment,
+at once produce myriads of animals, and bestow upon them motion, or in
+other words, the phenomena of sensibility. This, the experiments of
+Spallanzani, contrary to his own inclination, decidedly prove.
+
+If it be objected, that it may be as fairly argued, that sensation is
+something combined with these forms of matter, I answer, that we are not
+entitled to suppose any thing an independent being which never appears
+but in combination.
+
+Now, as we have shown that sensation is implicitly dependent upon, or
+connected with motion; and as this and all the other functions of the
+brain, are entirely the results and modifications of sensation, they also
+must be dependent on or connected with motion.
+
+Far be it from me to pretend to account for mental operation by mere
+physical motion. But, that motion accompanies all these processes, I am
+certain; nor can the supposition that motion is made use of in the most
+mysterious operations of the mind, possibly detract from the honour of a
+Deity, or from our admiration of natural operations.
+
+We have little need to be afraid of a moderate and rational materialism.
+It is the idealism of Berkeley, it is the scepticism of Hume—those
+dangerous opponents of such materialism, that have so deeply injured
+philosophy and religion. It is according to these systems, that prophets,
+apostles and miracles, are only ideas in the mind; and, indeed, the
+unreasonable dislike to a rational materialism, is alone chargeable with
+having led to the dangerous scepticism of Hume.
+
+That physiologists, then, should so long have permitted others to
+encroach upon their proper province, is disgraceful to them, and has
+been most mischievous to science. To this is owing the barbarism of the
+doctrine of mind. As physiologists abandoned it, philosophers found it
+difficult to give it a name.—Some called it morals—others metaphysics—and
+others, the philosophy of the mind. But I have just endeavoured to shew,
+that it is neither morals nor metaphysics, nor the philosophy of the
+mind—but the philosophy of the intellectual organs of the human body.
+
+
+
+
+FIRST PRELIMINARY LECTURE TO THE COURSE OF PATHOLOGY AND THE PRACTICE
+OF MEDICINE; EXHIBITING THE OUTLINE OF A NATURAL SYSTEM OF PATHOLOGY,
+MEDICINE AND THE MATERIA MEDICA.
+
+
+GENTLEMEN,
+
+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.
+
+I shall now, then, proceed to point out the mode of obviating this state.
+
+       *       *       *       *       *
+
+These seem to me to be points eminently worthy of consideration, and
+the best mode of obviating the objections they involve, is a greater
+attention to natural theory and arrangement.
+
+But, in order perfectly to remedy these great defects, the cultivation
+of physiology is primarily necessary. As far as the accumulation of
+facts goes, it has, however, already been cultivated, and that most
+assiduously. But before these accumulated facts can afford a principle of
+medicine, they must afford a theory of physiology, and, before they can
+afford this, they must be arranged according to their relations to each
+other.
+
+I may here observe, that the sciences alone afford theories, the arts
+admit merely of principles upon which these reasonings or theories are
+applied to the wants of man. Thus, in every step of their progress, the
+arts must implicitly depend upon the sciences.
+
+Now medicine is purely an art and admits of a principle derived from
+physiology by which the theories of that science may be applied to the
+cure of diseases.
+
+As, however, no general theory of physiology exists, it becomes necessary
+to inquire what systematic arrangement can be given to its facts, as
+strictly founded on those of anatomy, in order to obtain one. And I know
+none so unexceptionable as that arrangement which I have already publicly
+delivered, nor any general theory so rational as the one which results
+from it.
+
+I shall now, therefore, restate these arrangements, and then try their
+applicability to the medical art.
+
+       *       *       *       *       *
+
+Anatomy I divide into three parts, namely, that which considers the
+mechanical or loco-motive organs, that which considers the vital organs,
+and that which considers the intellectual organs.
+
+Under the mechanical or loco-motive organs, I class, first, the bones
+which support the rest of the animal structure; second, the ligaments
+which unite them; and, third, the muscles which move them.
+
+Under the vital organs, I class, first, the organs of digestion, the
+absorbent surfaces, and the vessels which absorb from these surfaces;
+second, the heart, lungs and blood-vessels which derive their contents
+(the blood) from the absorbed lymph; and, third, the organs of secretion
+which separate various matters from the blood.
+
+Under the intellectual organs, I class, first, the organs of sense, where
+impressions take place; second, the brain or organ of judgment, where
+these excite ideas; and, third, the nerves, where volition results from
+the last.
+
+This is a natural arrangement of the anatomy of animals, and its peculiar
+simplicity is illustrated by its involving, in application, that of
+minerals and vegetables, and by its being capable of instant adaption to
+physiological science.
+
+In order to arrange animal physiology, it is only necessary to substitute
+the term “functions” for “organs;” and that science will likewise
+involve, in application, the physiology of mineral and vegetable bodies,
+and be, in its turn, capable of instant adaption to medical science.
+
+Thus, the functions also are divided into mechanical, vital and
+intellectual.
+
+The mechanical functions are subdivided into that of support, that of
+connection and that of loco-motion.
+
+The vital functions are divided into that of absorption, that of
+circulation and that of secretion.
+
+The intellectual functions are divided into that of sensation, that of
+mental operation and that of volition.
+
+In order to arrange medical science, for the term “healthy functions,”
+the subject of physiology, it is only necessary to substitute the term,
+“diseased functions.”
+
+The classes of disease are, therefore, like those of anatomy and
+physiology, three, namely, diseases of the mechanical or loco-motive
+functions, diseases of the vital functions, and diseases of the
+intellectual functions.
+
+The orders of the first class, as affecting the functions of the bones,
+the ligaments and the muscles, are three, viz. diseases of support,
+diseases of connection, and diseases of loco-motion.
+
+Those of the second class, as affecting the functions of the absorbent,
+circulating and secreting vessels, are likewise three, viz. diseases of
+absorption, diseases of circulation and diseases of secretion.
+
+Those of the third class, as affecting the functions of the organs of
+sense, of the brain and of the nerves, are also three, viz. diseases of
+impression, diseases of judgment and diseases of volition.
+
+The genera, under each order, consist of diminished, irregular and
+increased function.
+
+This arrangement of disease likewise involves in application, that of
+minerals (if we choose to maintain the analogy and to give that term
+to mere injury of structure) and of vegetables, as well as animals.
+The first have what may be termed diseases of mechanical structure;
+the second have diseases of mechanical and vital functions; whilst the
+third have diseases of mechanical, vital and intellectual functions;
+corresponding with the observation that animals exist, vegetables exist
+and live, and animals exist, live and think.
+
+Precisely in the same way, would I class the articles of the materia
+medica; first, as operating upon the mechanical, vital or intellectual
+organs, and then as either increasing, rendering irregular, or
+diminishing their action.
+
+In this natural arrangement, I must again remark, that all its parts
+correctly correspond and beautifully flow from each other; while anatomy
+is the basis of physiology, physiology, in its turn, is the basis of
+medicine; the classification of one is applicable to the rest, and all of
+them at once involve mineral, vegetable and animal nature.
+
+Such arrangement, as it lays the foundation of a new system of each,
+will, I trust, soon shed some light over anatomical, over physiological,
+and particularly over the dark paths of medical science; but it must be
+remembered, that this exhibits merely a sketch of the application of my
+general arrangement to medical science, and that sketch necessarily brief
+and deprived of every illustration. Yet, even after this sketch, I think
+I may add, in the words of Lord Bacon, that “the harmony of a science,
+supporting each part the other, is and ought to be the true and brief
+confutation and suppression of all the smaller sorts of objections.”
+
+I shall now, however, further explain the principles upon which the
+natural system is constructed.
+
+       *       *       *       *       *
+
+The correctness of this arrangement, as strictly founded on physiology,
+is confirmed by the following observations.
+
+Disease is change of the healthy state and of the healthy action of
+parts. It is change of the state as well as of the action of parts,
+because action depends on state, life itself on organization, and it is
+only by affecting this state—the structure of the objects acting, that
+change of action can be produced. In fracture, as far as the bone is
+concerned, the action peculiar to it—loco-motion is affected; as the
+blood-vessels are ruptured, their action is affected; as the nerves are
+injured, their peculiar action is also affected.
+
+Thus each has its peculiar action, and the action of each is affected
+through the medium of its structure; but the affection of the state and
+action of the vessels or nerves is not, in fracture, the primary disease,
+but only an extension of it to other parts or other functions, or, more
+properly, they are new diseases, because they affect new functions, and,
+though dependent upon it, are, in their nature, entirely different from
+fracture—the primary disease.
+
+The action, for instance, of vessels in absorbing, circulating and
+secreting, so far as, in vegetables, for instance, the form and
+arrangement of their capillary tubes are concerned, or the continuation
+of the action commenced in these tubes, or the effusion of their
+contents when ruptured, is evidently independent of nerves; and I
+believe, were this principle traced further, it would be found to account
+for many of the actions of animal as well as vegetable parts. Whether
+true or false, however, it cannot materially affect the system. For
+whether their action is dependent on nerves or not, it is, strictly
+speaking, their own action, and, by injury, they are rendered incapable
+of performing it.
+
+Disease may thus properly be defined, any change of the healthy state
+and healthy function of parts. If any one urge, that disease implies
+the action, not the state of parts, I grant it; but must observe that
+_change_ of state is action, and change of healthy state is evidently
+morbid action or disease, whether it arises from within or without,
+whether suddenly from external and accidental causes, or more slowly
+within the body and in dependence upon other previous derangement.
+
+Indeed to trace any disease back through previous derangement is actually
+to trace out other diseases, and to define any disease from others
+thus traced out, is to abandon those distinctions which separate the
+termination of one disease from the commencement of another.
+
+If any one still assert, that disease is not change of the state but
+change of the action of parts, and urge that those accidents which
+depend on external causes, as fracture, considered in themselves, are
+not disease, I should say, were this even proved, it could only affect
+my arrangement by giving the term injuries, instead of diseases, to the
+first class. As, however, it seems to me that they may justly be named
+diseases, and that practically considered they are precisely the same,
+I shall retain that term. Thus, we shall have a fairer view of the
+interesting analogies which, as will be seen, exist between the animal,
+vegetable and mineral worlds.
+
+Now, if disease consist in change of function, different diseases must
+either consist in different changes of the _same_ function or in the
+changes of _different_ functions; the former, viz. different changes of
+the _same_ function, as being a more minute division, making evidently
+the genera which are subordinate; the latter, viz. changes of different
+functions, as being more general, forming the orders which include these
+genera.
+
+From the inspection of the table, and a consideration of the nature of
+disease, it will appear, that whatever is commonly reckoned one disease,
+is generally, perhaps always, three; thus fracture is always accompanied
+by inflammation and pain; and while the simple fracture is a disease
+of diminished support, the inflammation caused by it is a disease of
+increased circulation, and the pain caused by it a disease of increased
+impression.
+
+As individual diseases are not arranged under the table, I may, in order
+to render my meaning perfectly obvious, give one or two examples of
+this mode of classification. Thus with regard to the classes or first
+and most general divisions of disease, _fracture_ is a disease of the
+mechanical functions, _syphilis_ of the vital functions, and _mania_ of
+the intellectual functions. With regard to the orders or second and less
+general divisions of disease in the last of these classes, _amaurosis_
+is a disease of impression or sensation, _mania_ of mental operation,
+and _paralysis_ of expression or volition. And with regard to the genera
+or subdivisions of disease in the second of these orders, _fatuitas_ is
+a disease of diminished mental operation, _mania_ of depraved mental
+operation, and _vigilia_ of increased mental operation. Farther, with
+regard to the combination of disease under the last class, (sleep
+itself consisting in the quiescence of almost all the intellectual
+functions), _dreaming_ consists chiefly in the quiescence of sensation,
+_somnambulism_ chiefly in that of mental operation and _incubus_ chiefly
+in that of volition.
+
+With regard to the articles of the materia medica, or rather with
+regard either to external or internal applications, the correctness
+of my arrangement, as indicating their influence upon the different
+classes of organs, will, on the slightest consideration, appear equally
+evident; pressure, for instance, affects the mechanical, mercury the
+vital and opium the intellectual system. But, like the diseases which
+they remedy, it will appear, that each of these also affects all of the
+functions, though in a less direct manner than that which I have just now
+particularly pointed out as its object, and upon which the exact place of
+each in a systematic arrangement ought to depend.
+
+It cannot, therefore, be a just objection to this arrangement, that it
+throws each of what are commonly called diseases under these different
+classes, as, in reality, each of the common diseases is more properly
+three, and exists under three natural classes. Even in this way, does
+every physician, though unaware of it, consider them, and therefore,
+instead of giving any new complexity to nosology, it merely explains
+and simplifies that complexity which ever has existed in the nature of
+disease. In other words, it is natural, and developes and simplifies only
+the combinations of nature.
+
+Thus, no one disease, properly so called, can, with the slightest truth,
+be said to fall under three different classes, as inflammatory and
+suppurative phthysis, which are even commonly reckoned distinct stages,
+or as fracture, inflammation, &c. which are essentially different in
+their nature and may actually be combined in every possible form. Thus
+it can serve no useful purpose to reckon them one disease, while it
+destroys every natural arrangement and all the invaluable consequences
+dependent on it, and absolutely leads first to confusion, next to false
+reasoning and then to the most fatal errors in actual practice.
+
+Although, however, nosology must thus, in any thing like a natural
+arrangement, be fixed most accurately upon the basis of physiology,
+the classification of every disease may be derived from the particular
+derangement of that individual function which occasions the derangement
+of all the rest, and not from the derangement of all the three functions
+which would render names uselessly complex.—I say uselessly, because, as
+the whole of any one disease, commonly so termed, is primarily dependent
+on the derangement of one function, so health is to be recovered chiefly
+by the restoration of that function, and the mode of cure is chiefly
+indicated by the name of genus under which the disease is _primarily_
+arranged. This last is one of the most important consequences of such a
+system.
+
+If, however, the names of diseases and their classification are not thus
+made dependent most strictly on each specific change from the healthy
+state described in physiology, they are at once arbitrary and unnatural;
+the pathology and nosology of which they constitute a part, have not
+their foundation in physiology, nor is the practice constructed upon them
+indicated by the reasonings it delivers.
+
+To reckon a series of occurrences which entirely differ in their nature,
+consequences and mode of cure, as one disease, may serve the purposes of
+common language, but by no means those of medical science and medical
+arrangement.
+
+In considering the natural arrangement of medical science exhibited
+above, it will be particularly necessary to avoid substituting the term
+“organ” for “function.” The term “diseases of organs” expresses merely
+the seats of disease, whilst the term “diseases of functions” expresses
+their nature. Nevertheless a reference may also be made to the various
+organs, as it is evident that there may be disease of the vital or
+any other function in a mechanical organ. Thus a tumour in a bone is
+a disease of secretion, or an ulcer in a similar situation a disease
+of absorption; both being orders of the class—Diseases of the vital
+functions.
+
+The first principle of the medical art, therefore, is founded upon a
+knowledge of the relations subsisting between the various states of
+the animal functions and the power of medicines, as exhibited in the
+preceding sketch of a natural system; and it consists in the application
+of the articles of the different genera of medicines (exhibited in the
+last column of the table) to the cure of the corresponding genera of
+disease (exhibited in the third one).
+
+       *       *       *       *       *
+
+One of the most beautiful results of the principle I have proposed is,
+that, by its adoption, it will be possible for the physician to lay his
+hand upon the several columns of a table, each of which, with regard to
+the diseases which it enumerates, is precisely similar in its nature from
+commencement to end; indicates correspondingly arranged articles of the
+materia medica, and requires precisely a similar mode of cure.
+
+As the same arrangement is applied to the articles of the materia medica,
+the corresponding medicine will evidently, in every case, readily present
+itself to him.
+
+But the most signal advantage resulting from it is, that, by merely
+assigning to any disease its place in nosology, the physician will
+instantly indicate the mode of cure which ought to be adopted for it.
+
+I shall now then, Gentlemen, conclude by this important remark, that
+happily the tendency of this natural system of disease is not to
+controvert one established fact, but, by pointing out their relations,
+to simplify, consolidate and if possible to increase the amount of our
+knowledge on all the subjects of medicine.
+
+
+
+
+SECOND PRELIMINARY LECTURE TO THE COURSE OF PATHOLOGY AND THE PRACTICE OF
+MEDICINE; EXHIBITING A FUNDAMENTAL PRINCIPLE OF SURGICAL OPERATION.
+
+
+GENTLEMEN,
+
+The vague plans of Surgical operation, at present practised, are too
+generally known, and too sincerely deplored, by every man of science and
+of feeling, to demand much of comment on the present occasion.
+
+How often, in the attempt to take up an artery, does the ignorant and
+timid operator make an incision so limited that he is afterwards forced
+cruelly to extend it! How often, having extended his incision, does he
+find no artery beneath it, and dig or mine for it in a new direction, by
+cutting up the flesh of the patient! How often, having reached the place
+he sought for, does he mistake another artery, a nerve, or even a vein,
+for that which ought to be the subject of operation! How often, having
+found the artery, is he at a loss to recognize it! What trepidation and
+alarms does not this operator, more miserable than the patient himself,
+endure!
+
+I know no situation more wretched or more pitiable than this. Here,
+even at the best, the most exquisite torture is inflicted: the poor
+trembling patient, abstracted from every other earthly object, and with
+the most exquisite feelings concentrated on the present, awaits, in awful
+suspence, the impending stroke which is to divide the skin, that seat of
+accumulated sensibility, and deliver him from wretchedness; but the hope
+is vain, his torments are again and again renewed; he perceives that his
+life is the sport of a fool; he writhes in agony, or sinks in deliquium;
+and the issue is, as might be expected, too generally, even at the best,
+unsuccessful.
+
+When all this is not the case, how often does the operator, on the
+contrary ignorant and rash, plunge his knife into some vital organ of the
+patient, and at once terminate his life and his diseases?
+
+That this picture is not too highly coloured, I solemnly appeal to the
+conscience and the feelings even of the best operators, who are too
+candid to deny that melancholy reflection has often oppressed them from
+the fate of patients—martyrs to their want of precision.
+
+       *       *       *       *       *
+
+To obviate this train of miseries; to give ease and satisfaction to the
+operator, by conferring precision and success upon his operation, and
+to rescue from death, or rather from torture and agony, innumerable
+sufferers, are the results which I confidently expect from the adoption
+of the following method. Nor can I say more in proof of its importance.
+I doubt not, that it will, ultimately, constitute the basis and direct
+the genius of surgery.
+
+       *       *       *       *       *
+
+There exists no other method of effecting this, than by the enunciation
+of the following principle; namely, that there is, especially in such
+parts as are not liable to be deranged by voluntary motion, an invariable
+relation between the arrangements of internal and the situation of
+external parts, which may justly be considered as accurate signs of them;
+in consequence of which, by adopting, on each side of the nerve, artery
+or other subject of operation, a fixed point, or one rendered fixed by
+particular positions of the body; and by dividing, according to a line
+or rule, the space between these fixed points into a given number of
+proportional parts, _i. s._ parts, not equally large in all subjects,
+but uniformly of the same size, with relation to the whole which they
+compose, and generally differing in the male and female—by these means, I
+say, the situation of any given subject of operation, in any given part
+of the body, may be most accurately indicated, as being undeviatingly a
+certain number of proportional parts distant from the one, and a certain
+number from the other of these points.
+
+Thus does anatomy, by what I term precise or real proportional
+measurements between fixed points, afford an obvious and simple, though
+hitherto unobserved, general means of rendering the operations of surgery
+perfectly precise and easy.
+
+Indeed, such wonderful precision and ease do these real proportional
+measurements confer, that, by means of them, the finest instrument may be
+passed from the surface of the body through any great nerve or vessel
+that is liable to be the subject of surgical operation.
+
+Having stated this principle, I may merely observe, that, proceeding
+with all the ease and security, such accuracy must infallibly confer,
+it is, in all operations the first duty of the operator to ascertain
+by feeling, as nearly as possible, the thickness of cellular substance
+situate immediately under the skin of the patient, and then, with a bold
+and steady hand, to make an incision, deep in proportion to the thickness
+of that substance, and long in proportion to its depth, as well as to the
+additional depth and extent of the part to be operated upon.
+
+These general principles excepted, other subordinate rules are chiefly
+applicable to particular operations.
+
+       *       *       *       *       *
+
+In order to illustrate this general principle, I cannot adduce a fairer
+or a better example than that which, according to it, is necessary to
+direct the taking up of the subclavian artery above the clavicle.
+
+The patient must, in this operation, rest on the fundament, his body
+slightly inclining backward, so as to form an obtuse angle with the
+thighs, and his neck and head inclined backward so as to form with the
+trunk an angle similar to that formed by it with the thighs; the inferior
+of these angles being concave, the superior convex. This last may indeed
+be more properly called an irregular segment of a circle, formed in
+consequence of the vertebrae of the neck bending in that direction. In
+this position, therefore, the neck is, in general, in the same parallel
+with the thighs. The head of the patient is to be turned to the opposite
+side from that in which the operation is to be performed, where also the
+operator must stand. The light must fall directly downward from the head
+of the patient.
+
+In this case then, the bringing of the shoulder forward and downward,
+which I deem indispensible, however necessary to the ease of the
+operator, is not very material to the correctness of the measurement.
+It is however of some consequence; for, as the subsequent measurement
+is dependent on the clavicle, and as that bone describes a portion of
+a circle in having its lateral end brought forward, every single point
+of it would, in that position, have a different relation to the vessels
+beneath from that which each would have had, if kept in its usual
+position.
+
+Here then, the shoulder being in this position, and the arm held by the
+side, the measurement commences, and the fixed point chosen on each side
+of the immediate subject operation are the two ends of the clavicle; as
+nearly between these as can be done, consistently with keeping quite
+clear of the bone, a line must be drawn superior and internal to it,
+and the given number of proportional parts, into which this line must
+be divided, are seven in number both in the male and female; and now
+the situation of the artery may be most accurately indicated as being
+undeviatingly three of these proportional parts distant from the inner,
+and four from the outer end of the clavicle; in consequence of which, if
+a fine instrument, held at right angles to the clavicle, were directed
+downward and inward, it would at 1 and ¼ of the above mentioned parts
+from the surface of the clavicle, reach the artery, and being pushed
+farther, would pass through it.
+
+This is an absolute demonstration of the precision and ease attending the
+principle I have announced, and of its applicability even to the most
+difficult of all operations.
+
+In order, however, to perform the operation throughout, the point which I
+have indicated must be the center of an incision through the integuments
+made in the line above mentioned, and must extend at least two parts
+inward and two outward from the central point. Over the Trapezius
+outward, and over the clavicular attachment of the Sterno-cleido-mastoid
+muscle inward, it is not adviseable to cut deeper than the integuments,
+which sufficiently relieves the hand of the operator, without the present
+execrable practice of dividing the last mentioned muscle, which is not
+only unnecessary, but highly faulty, as this attachment serves as one
+of those particular points, above alluded to, incidental to certain
+operations, which, by means of its edge, kept lax during the operation,
+very nearly directs the knife to a small protuberance on the superior
+anterior surface of the first rib to which the scalenus primus is
+attached, and immediately external to which the artery itself lies.
+
+Above all, the incision ought to be cautiously continued on the inner
+side, in order to avoid the large veins situate there; various branches
+of these veins may come in the way, and the more considerable may be
+easily avoided, but if not, they may be tyed.
+
+In continuing the incision inward and downward, an ascending branch
+of the vein is in the way, which, when it is considerable, may also,
+previous to the continuance of the incision, be tyed. The incision
+itself, as you pass inward, must be very limited indeed, as the jugular
+vein is internal to it; and external to it there is a twig of the
+brachial nerve, both of which are much exposed to injury.
+
+When the incision has been made one and a fourth of these proportional
+parts inward from the outside of the clavicle, you have reached the
+artery. It lays external to that protuberance of the first rib into
+which, as already observed, the scalenus primus is inserted, and
+consequently to the insertion of the muscle itself. The twig of the
+nerve actually crosses the artery immediately below the point where the
+latter ought to be tyed. The course of the artery is, in descending,
+obliquely outward, and the precise space in which it lays resembles
+an isosceles triangle formed by the clavicle, clavicular portion of
+the sterno-cleido-mastoideus and the omo hyodeus; its base being the
+clavicular portion of the sterno-cleido-mastoideus. The nerve is external
+and anterior to the artery, particularly its branch. Both the twig and
+trunk of the nerve ought to be seen by the operator before he attempt to
+take up the artery.
+
+These directions are so precise, that, were the operator blind and the
+artery destitute of pulsation, he need not scruple to take up that which
+presents itself in the above mentioned situation.
+
+By similar measurements, may every great artery in the body, liable to
+be the subject of surgical operation, be discovered with similar ease
+and precision, nor does there exist any other method of effecting this
+purpose.
+
+I shall now then state the objections which may be urged against this
+principle.
+
+       *       *       *       *       *
+
+It may be objected to the adoption of this fundamental principle of all
+surgical operation.
+
+_1st_, That the accidental and probable fracture of the bone affording
+the fixed points, would, by deranging these points, render all such
+measurement inapplicable.
+
+_2d_, That varieties in the distribution of arteries, and those
+deviations which are often produced by disease, would have the same
+effect.
+
+I know not of any other objection that can be urged against it, and these
+I shall immediately answer.
+
+       *       *       *       *       *
+
+_1st_, To the objection that the accidental and probable fracture of
+the bone affording the fixed points would, by deranging these points,
+render all such measurements inapplicable, I answer, that, to chuse as
+an example the operation I formerly described, it is, in such a case,
+only necessary to transfer the measurement to the sound clavicle,
+and to convert the three inner or four outer proportional parts into
+absolute inches, quantities similar to which may then be measured from
+the corresponding ends of the fractured one, and thereby indicate the
+situation of the vessel or nerve with as great precision as if no
+fracture were involved.
+
+_2d_, To the objection that varieties in the distribution of arteries,
+and those deviations which are often produced by disease, would have the
+same effect, I answer, that variety of distribution does not at all take
+place in some of those parts in which the most important operations have
+to be performed; namely, high in the groin, above and below the clavicle,
+&c. and that, wherever great deviation is caused by disease, it will
+generally be attended by external signs, according to which the operator
+may modify his measurements. I also further answer, that wherever
+deviation, from either of these causes, occurs, he who, by means of these
+measurements, knows the precise situation, according to the most usual
+and regular structure, will have the most decided advantage over him
+who is ignorant of it: the former will possess data, from which he can
+calculate probable deviations, the latter none; the former, even at the
+worst, will have to _calculate_, the latter will be unable to do more
+than _guess_.
+
+Thus I have answered the only objections that it is possible to urge
+against the principle proposed.
+
+I have already said, that private objections by persons who dare not
+publicly make one, and who themselves cannot, by one or two incisions,
+approach within several inches of any artery, I shall uniformly despise,
+and shall only ask them to perform the operation with my youngest pupil.
+
+I shall now deliver a short history of the method proposed.
+
+       *       *       *       *       *
+
+The want of some guide to the situation of internal parts, has long
+been felt. Fixed points have been adopted, but with no regularity.
+Measurements guessed by the eye have sometimes been used, but even
+they have almost always been absolute, _i. s._ measurements from one
+point; rarely proportional, _i. s._ measurements between two points.
+The few guessed proportional measurements, however, as for paracentesis
+abdominis, paracentesis thoracis, &c. which have been mentioned in
+surgical works, have, it must be confessed, been such as, from the
+magnitude of the parts with which they were concerned, required little
+more than guess. Such, however, as they were, they evidently depended
+upon no principle, but seem as if hit upon accidentally, and, at all
+events, were never generally applied.
+
+Precise or real proportional measurements between fixed points,
+applicable to minute objects, _i. s._ such measurements as I have
+proposed and described, never have been, as far as I can discover,
+proposed and described before. And these precise or real proportional
+measurements, between fixed points, differ exactly as much from guessed
+ones, as the accurate cabinet, which was regulated in every part by the
+compass and square, would differ from the clumsy and unserviceable one,
+where every thing was constructed by guess. Here the parallel is so
+close, the difference in the results so striking, that I could not have
+adduced a better illustration.
+
+The present proposition, of precise or real proportional measurements
+between fixed points, was communicated by me, about five or six years
+ago, to James Macartney Esq. lecturer on comparative anatomy, and the
+laws of organic existence, at St. Bartholomew’s Hospital, and, in my
+opinion, one of the best comparative anatomists in Europe. I had no
+sooner announced it, than he assured me that a similar method had struck
+himself; and I deem this, so far as authority goes, no mean testimony in
+behalf of its value.
+
+Mr Macartney, some time afterward, performed upon the dead subject,
+in the dissecting room at St. Bartholomew’s, the difficult operation
+I have just described, according to the direction I have given, and
+both politely acknowledged me as the proposer, and bestowed on it his
+approbation. It is my duty to remark, that there is no person whose
+approbation could give me higher satisfaction.
+
+       *       *       *       *       *
+
+I cannot better illustrate the danger arising from ignorance of this
+principle, than by quoting an instance of repeated failure in the very
+operation above described, in consequence of such ignorance.
+
+A professor at an hospital in London, generally reckoned one of the
+ablest surgeons of the metropolis, when illustrating this operation in
+his lectures, first made the usual guessed cut, passing across one half
+of the Sterno-cleido-mastoid muscle; and, after some tearing and cutting,
+and innumerable complaints against the knives and the unfortunate
+assistant, told his pupils, “that they might think he had not yet got the
+artery, but he knew he had, and he should know it in the living subject,
+even if it did not pulsate.” The subject, however, was carried from the
+lecture-room, and the ligature was found to be firmly fixed upon the
+nerve.
+
+This mistake was very properly communicated to the ingenious surgeon,
+who never forgave the discoverer of it, but very wisely planned how he
+might avoid the same mistake, or, what he seemed to dread most, its
+consequences to his own reputation, in the subsequent course.
+
+He had thus found, that ligatures left in the dead subject were more
+troublesome than in the living; and having tied something, which, to
+judge from the vague way in which he described it, might be a muscle as
+readily as an artery, he very properly, as his mind was not quite made up
+upon the subject, secured, to all appearance, his well earned fame, by
+cutting off and withdrawing the ligature that nobody might see what he
+had done.
+
+Unfortunately, however, curiosity and the wonder that it was possible for
+so great a surgeon to make so deplorable and dangerous an error, prompted
+a second examination of the subject. No ligature now remained to direct
+the enquirer’s search; but alas! artifice could not obtain impunity even
+to reputation—the artery remained bedded in fat and untouched, the nerve
+alone was separated from the mass, and bore the mark of the ligature.
+
+May the relation of these disgraceful occurrences, selected from numerous
+similar ones, which, to my knowledge, have taken place both in London
+and Edinburgh; but which, as, fortunately for their authors, they produce
+no injury to reputation, I am therefore unwilling to state—may it, I say,
+serve as a proof of the danger arising from ignorance of the principle I
+have proposed.
+
+Now, may I ask, what are we to think of the supporters—the promulgators
+of such doctrines, and the abettors of their authors? Such men are to be
+found in Edinburgh, as well as in London.
+
+Suppose, for a moment, one of these gentlemen, who are the deriders of
+precise and accurate methods, proposing to perform on the dead subject,
+in the most fascinating and splendid style, the operation for tying the
+femoral artery. He delivers a proem which shall verbally assure the pupil
+of its ease, but, by the complex flourishes of his knife, he intends to
+convince him it is difficult. He expects, however, that he shall speedily
+lay it bare, and that his dexterity, in the midst of such complexity,
+will produce the most brilliant effect. But alas! his first incision
+is made about an inch from the artery—still he cuts deep, in order to
+discover it—now he is embarrassed at his situation—next he mines off
+laterally, forms excavations under the flesh, and leaves the artery above
+the course of his incision—at last he reaches the profound, instead of
+the superficial artery, and comes off with the never-failing, and, in
+this case, ridiculous excuse, that there was an unusual distribution of
+it.... The errors of Surgeons have very curiously discovered a greater
+number of varieties in the distribution of arteries than ever were
+demonstrated by the labours of anatomists.
+
+I have seen one of these surgeons commence such a disgraceful operation
+with more flourishes of the knife, than ever a dragoon used when
+performing the Saxon exercise with the sabre. Contrast this with the
+plain and manly operator, every movement of whose knife has a meaning,
+because every movement of it is strictly adapted to effect the most
+useful of purposes.[1]
+
+    [1] It may be surprising, but it is not inconsistent with human
+    nature, that such men should be the persecutors of others; and
+    it may perhaps be worth while to quote a few sentences from the
+    production of such men directed against myself.
+
+    “While an intimate acquaintance with the Anatomy of the human
+    body, is absolutely necessary to him who wishes to practise
+    Surgery, with credit and success, it must be acknowledged, that
+    _those who are much occupied with dissection, are but too apt
+    to overrate the practical importance of a minute knowledge of
+    healthy structure_. That surgeon would indeed justly hazard the
+    imputation of rashness and presumption, who would (_should_
+    is here meant) imprudently venture to apply a ligature to
+    the carotid or subclavian arteries, or attempt to remove the
+    stricture in a strangulated crural hernia, without an accurate
+    knowledge of the assemblage of important vessels which are
+    included in the regions of the neck and groin: yet _we do
+    not allow ourselves to be much influenced by the opinions of
+    the anatomist who affirms, that there are certain fixed and
+    invariable rules, according to which, in every case, those
+    operations are to be performed_. We have learnt to infer, that
+    the different regions of the body include almost constantly
+    similar organs in every individual; and we know, that these
+    organs have usually a general relation to each other, in form,
+    magnitude, and position. Yet very little further observation is
+    sufficient to convince us, that these relations do not admit
+    of being determined with mathematical precision. The form
+    and position of parts, ascertained with the most scrupulous
+    accuracy in one individual, are not to be adopted as the
+    basis of a system of rules, by which the operative surgeon
+    is invariably to be directed in the practice of his art. To
+    inculcate on the minds of the inexperienced, that surgical
+    operation consists merely in the study of the external form,
+    and that it is solely regulated by the mathematical bearings of
+    certain prominences and depressions on the surface of the body,
+    is to encourage the rash and the ignorant to sport with the
+    lives of their fellow creatures, and entail disgrace and misery
+    on themselves.”
+
+    What must the liberal and candid think of this, when they are
+    informed that the misrepresentations which I now quote, are the
+    production of a party, of whom more than one intends to give
+    a course of lectures on subjects similar to the man against
+    whom they privately direct these attacks!... What they want
+    in intellect and genius, they compensate for in numbers and
+    in stratagem. I am aware that these gentlemen may influence
+    some of better minds than their own; but I shall entrust their
+    confutation and their shame to demonstration and the evidence
+    of facts.
+
+    When _I_ have mistaken the femoral artery for the profunda;
+    when _I_ have taken up arteries in amputation before sawing
+    off the bone; and when, in attempting to perform the operation
+    of Lithotomy, _I_ have been forced to abandon it, publicly
+    to attempt an explanation in apology for the blunder, and
+    then obliged to leave it, to see whether THE STONE WOULD COME
+    AWAY OF ITSELF! or be, as is perpetually the case on similar
+    occasions, privately extracted by another—when I have done
+    all this, and made myself an object of laughter even to the
+    youngest pupil—then, then I shall cease even to speak of
+    Surgery or Medicine.
+
+I have now only to add a few words concerning the necessity of such
+precise methods of operation in the present military state of Europe.
+
+       *       *       *       *       *
+
+While such important operations remain in so vague a state, what ease
+would not such measurements confer, when, in the cockpit of the man of
+war or on the field of battle, the perplexed and bewildered surgeon knows
+not where to turn him, but must leave an hundred operations in an hour to
+an unexperienced assistant.
+
+At a time, when a successful conspiracy of adventurous ruffians are, at
+the point of the bayonet, establishing, from the Don to the Douro, from
+the Scheldt to the Cattarro, over all the fairest provinces of Europe,
+the most dreadful of military despotisms;—at a time, when, to the shout
+“Avance, Avance,” louder and more tremendous than the noise of their
+guns, the myriad legions of France are carrying death and destruction
+before them, and sweeping together man and civilization from the face of
+the Continent;—at a time, when he who has “sceptres tipt with coronets
+for his pallisadoes, kingdoms for his martello towers and kings for his
+centinels,” threats at once the liberties and the existence of Britain,
+and stains every step of his career with perfidy and blood;—at a time,
+when it is the duty—it is the wish of every man of honour successfully
+to defend, or, covered with wounds, nobly to die for the liberties of
+Britain and the emancipation of Europe—when all this is the case, what
+are not his duties whose sole profession it is, aided by science, to
+rescue from death or agony those whom tyranny has attempted to destroy,
+the genius of whose god-like art it is to save both friends and foes;
+and, upon whose knowledge, the existence and the fate of armies may, in
+no small degree, be said to depend.
+
+Never were the duties of the military surgeon more complex or more
+formidable. Never did he stand in need of greater precision. And, in his
+art at least, he ought to recollect that no commissions are sold—the
+precisest knowledge alone entitles to—infallibly secures, pre-eminence
+and fortune.
+
+
+
+
+_POSTSCRIPT._
+
+
+Since the publication of my Prospectus, and of the observations delivered
+in the previous note, the persons to whom that note alludes, have become
+ashamed of their conduct, and have, both in their lectures and through
+the press, asserted that I was not the object of their public attack;
+but that, _although it was quite unconnected with the object of the
+pamphlet in which it appeared_, yet they had taken the trouble to direct
+the attack against a gentleman at almost a thousand miles distance from
+them, and only two copies of whose book had ever reached the country;
+because, I suppose, they were alarmed lest, at that _short distance_,
+that gentleman should influence attendance upon their lectures, and lest
+a work so _widely diffused_ over the country should “encourage the rash
+and the ignorant to sport, _by means of accurate measurements_, with
+the lives of their fellow creatures, and entail disgrace and misery
+on themselves....” _Humanity_ is certainly deeply indebted to their
+generous, disinterested and philanthropic exertions! How much to be
+regretted that it has not ever had such guardians! Monuments doubtless,
+rivalling that of the hero of Trafalgar, will be erected to their
+memory—monuments of a nobler kind, because destined to record, not the
+triumphs of war, but the triumphs of lectureship in anatomy, physiology
+and surgery, which certainly involve, not the destruction, but the
+preservation of lives.
+
+What! M. Richerand, only at a thousand miles distance, influencing the
+_newly organized_ courses of lectures in Edinburgh, and _two copies_ of
+his dangerous book, proposing precise measurements in surgery, _actually_
+in the British empire.—Some gentlemen, perhaps, may be sufficiently
+ill-informed to imagine that the attack was really directed against so
+weak a creature as myself. How improbable! It is self-evident that I, _in
+Edinburgh_, could not have a thousandth part of the influence upon their
+lectures, that M. Richerand could _at the distance of a thousand miles_,
+and that my lectures, inculcating the principle _every day_, could not
+have a millionth part of the tendency to “encourage the rash and ignorant
+to sport, _by means of accurate measurements_, with the lives of their
+fellow creatures and entail disgrace and misery on themselves,” that _two
+copies_ of M. Richerand’s book, actually in the country, must infallibly
+have.... He would be almost mad who could suppose the allusion was to me,
+because I was at hand and _therefore_ could have no influence upon their
+lectures; I was delivering these opinions every day, and they _therefore_
+could not be disseminated: hence these gentlemen had no earthly interest
+in alluding to me. He, on the contrary, is wise who supposes that the
+allusion is to M. Richerand, because he is in Paris and _therefore_ must
+have great influence upon their lectures; of his book even two copies
+are in the British empire and its sentiments _consequently_ must be most
+widely disseminated; and it was _well contrived_ and _inexpressibly
+humane_ to introduce and firmly to oppose such a _desperate_ character,
+even in a work upon a _different subject_. In short, these gentlemen
+had the nearest interest in opposing him.... Well, it must certainly
+be highly satisfactory to have thus opposed the progress of error
+and rescued the human race from _disgrace_ and _misery_. Generous,
+disinterested, philanthropic defenders of _humanity_, you have your
+reward _in your own breasts_.
+
+But their apology will not bear the test of ridicule. Let us therefore
+examine, in another way, the foundation upon which it rests.
+
+After denying the truth of the principle they ascribe it to another.
+And who is ignorant that this has been the fate of every original
+proposition? M. Richerand, they say, discovered it in 1805. Now granting,
+for a moment, the truth of this, I preceded him by a year or two at
+least, and James Macartney, Esq. lecturer on comparative anatomy, even
+constructed, twelve months before the time they mention, a work upon the
+principle, for which he was favoured with drawings by Charles Bell, Esq.
+at the time the discovery is ascribed to M. Richerand. I mention these
+facts because, even granting the truth of what these gentlemen state, it
+refutes the assertions they found upon it.—I shall make a point of laying
+the further details on this subject (to me very important) before the
+medical world, which will show that, _even since I first enunciated the
+principle_, neither M. Richerand, nor any other person, has even repeated
+the proposition, and I defy these gentlemen to produce an instance of it.
+This, however, I must remark, even these gentlemen most inconsistently
+grant; for they say that the proposal, which they assert was made by
+M. Richerand, has been tried and has _failed_; whereas the proposition
+enunciated by me has been tried, has _uniformly succeeded_, and, such is
+its correctness, that it constitutes the basis of that part of my course
+which involves the operations of surgery. Therefore, even according to
+themselves, _the propositions cannot be the same_.
+
+I may now conclude by observing, that, notwithstanding the conduct of
+these gentlemen, I am far from bearing them any personal dislike,—but
+shall, on the contrary, be happy to labour with them in the same
+vineyard, and wish them the utmost success.
+
+       *       *       *       *       *
+
+Mr WALKER’S Course of ANATOMY and PHYSIOLOGY recommences on _Tuesday the
+8th of November, at_ ELEVEN O’CLOCK, a. m. and his Course of PATHOLOGY
+and the PRACTICE OF MEDICINE, at TWO O’CLOCK, p. m. and will be continued
+daily at these hours, at No. 63, SOUTH BRIDGE-STREET.
+
+*** END OF THE PROJECT GUTENBERG EBOOK 78678 ***