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diff --git a/78678-h/78678-h.htm b/78678-h/78678-h.htm new file mode 100644 index 0000000..5deff4a --- /dev/null +++ b/78678-h/78678-h.htm @@ -0,0 +1,2356 @@ +<!DOCTYPE html> +<html lang="en"> +<head> + <meta charset="UTF-8"> + <title> + Outline of a natural system of medical science | Project Gutenberg + </title> + <link rel="icon" href="images/cover.jpg" type="image/x-cover"> + <style> + +a { + text-decoration: none; +} + +body { + margin-left: 10%; + margin-right: 10%; +} + +h1,h2,h3,h4,h5,h6 { + text-align: center; + clear: both; +} + +h2.nobreak { + page-break-before: avoid; +} + +hr { + margin-top: 2em; + margin-bottom: 2em; + clear: both; +} + +hr.tb { + width: 45%; + margin-left: 27.5%; + margin-right: 27.5%; +} + +hr.chap { + width: 65%; + margin-left: 17.5%; + margin-right: 17.5%; +} + +div.chapter { + page-break-before: always; +} + +p { + margin-top: 0.5em; + text-align: justify; + margin-bottom: 0.5em; + text-indent: 1em; +} + +p.first { + text-indent: 5em; +} + +div.block { + margin: 3em auto auto auto; + width: 30em; + padding: 0.5em; + border-top: double black; + border-bottom: double black; +} + +.center { + text-align: center; + text-indent: 0; +} + +.footnote { + margin-left: 10%; + margin-right: 10%; + font-size: 0.9em; +} + +.footnote .label { + position: absolute; + right: 84%; + text-align: right; +} + +.fnanchor { + vertical-align: super; + font-size: .8em; + text-decoration: none; +} + +.hanging { + padding-left: 2em; + text-indent: -2em; +} + +.larger { + font-size: 150%; +} + +.pagenum { + position: absolute; + right: 4%; + font-size: smaller; + text-align: right; + font-style: normal; +} + +.right { + text-align: right; +} + +.smaller { + font-size: 80%; +} + +.smcap { + font-variant: small-caps; + font-style: normal; +} + +.allsmcap { + font-variant: small-caps; + font-style: normal; + text-transform: lowercase; +} + +.titlepage { + text-align: center; + margin-top: 3em; + text-indent: 0; +} + </style> + </head> + +<body> +<div style='text-align:center'>*** START OF THE PROJECT GUTENBERG EBOOK 78678 ***</div> + + +<h1><span class="smaller">OUTLINE<br> +<span class="smaller">OF A</span><br> +NATURAL SYSTEM<br> +<span class="smaller">OF</span></span><br> +MEDICAL SCIENCE.</h1> + +<hr class="chap x-ebookmaker-drop"> + +<p class="titlepage larger"><span class="smaller">OUTLINE<br> +<span class="smaller">OF A</span><br> +NATURAL SYSTEM<br> +<span class="smaller">OF</span></span><br> +MEDICAL SCIENCE.</p> + +<p class="titlepage allsmcap">FORMING THE PRELIMINARY LECTURES TO TWO<br> +COURSES: ONE ON ANATOMY AND PHYSIOLOGY;<br> +THE OTHER ON PATHOLOGY AND THE<br> +PRACTICE OF MEDICINE.</p> + +<p class="titlepage"><span class="smcap">By ALEXANDER WALKER, Esq.</span><br> +<span class="smaller">LECTURER ON PHYSIOLOGY, ETC.<br> +EDITOR OF THE ARCHIVES OF UNIVERSAL SCIENCE,<br> +&c. &c.</span></p> + +<div class="block"> + +<p class="hanging"><i>By pronouncing diseases incurable, physicians +have attempted to enact a law of neglect, and to exempt ignorance +from discredit</i>.</p> + +<p class="right"><span class="allsmcap">LORD BACON.</span></p> + +</div> + +<p class="titlepage">EDINBURGH:<br> +<span class="smaller">PRINTED AT THE UNIVERSITY PRESS.</span></p> + +<p class="center allsmcap">FOR SIR RICHARD PHILLIPS, NO. 6, BRIDGE-STREET,<br> +BLACKFRIARS, LONDON, AND<br> +MESSRS T. BRYCE AND CO. INFIRMARY-STREET,<br> +EDINBURGH.</p> + +<p class="center">1808.</p> + +<hr class="chap x-ebookmaker-drop"> + +<div class="chapter"> + +<h2 class="nobreak" id="TO"><span class="smaller">TO</span><br> +ALEXANDER MONRO, ESQ. SENIOR,<br> +<span class="smaller"><i>M. D. Professor of Medicine, Anatomy and Surgery, +in the University of Edinburgh, &c.</i></span></h2> + +</div> + +<p>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.</p> + +<p class="right">ALEXANDER WALKER.</p> + +<p class="smaller hanging"><i>2, North College Street,<br> +27th October 1808.</i></p> + +<hr class="chap x-ebookmaker-drop"> + +<div class="chapter"> + +<h2 class="nobreak" id="ADVERTISEMENT">ADVERTISEMENT.</h2> + +</div> + +<p><i>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.</i></p> + +<p><i>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.</i></p> + +<p><i>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.</i></p> + +<hr class="chap x-ebookmaker-drop"> + +<div class="chapter"> + +<p><span class="pagenum" id="Page_1">[1]</span></p> + +<h2 class="nobreak" id="PRELIMINARY_LECTURE"> +<span class="smaller">PRELIMINARY LECTURE<br> +<span class="smaller">TO THE COURSE OF</span></span><br> +ANATOMY AND PHYSIOLOGY;<br> +<span class="smaller"><span class="smaller">EXHIBITING</span><br> +THE OUTLINE OF A NATURAL SYSTEM OF<br> +THESE SCIENCES.</span></h2> + +</div> + +<p><span class="smcap">Gentlemen</span>,</p> + +<p class="first">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.</p> + +<p>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?</p> + +<p>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 +<span class="pagenum" id="Page_2">[2]</span>state of greater obscurity than that in which they found +them, that is the fault of physiologists, and not of their +science.</p> + +<p>In these lectures, I shall at least be influenced by the +deepest sense of such errors.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_3">[3]</span></p> + +<hr class="tb"> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>Anatomy, I divide into three parts, namely that +which considers the mechanical or loco-motive organs, that +<span class="pagenum" id="Page_4">[4]</span>which considers the vital organs, and that which considers +the intellectual organs.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_5">[5]</span></p> + +<p>Thus, the functions also are divided into Mechanical, +Vital and Intellectual.</p> + +<p>The mechanical functions are subdivided into that of +support, that of connection, and that of loco-motion.</p> + +<p>The vital functions are divided into that of absorption, +that of circulation, and that of secretion.</p> + +<p>The intellectual functions are divided into that of sensation, +that of mental operation, and that of volition.</p> + +<p>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.</p> + +<p>The plan of the course will, therefore, be precisely +the same with that which I have proposed for Anatomy +and Physiology in general.</p> + +<p>I. In that part of the course which relates to the mechanical +organs and functions, will be explained the structure +and uses, <i>1st</i>, of the bones which support the rest of +the animal machine; <i>2dly</i>, of the ligaments which unite +it; and <i>3dly</i>, of the muscles which move it.</p> + +<p>II. In the first part of the course which relates to the +vital organs and functions, will be explained the structure +and uses, <i>1st</i>, of the organs of mastication, deglutition and +digestion, of the absorbent surfaces, and of the vessels which +absorb from these surfaces; <i>2dly</i>, of the heart, lungs and +blood-vessels, which derive their contents, (the blood), +from the absorbed lymph; and, <i>3dly</i>, of the organs of secretion, +which separate various matters from the blood. +<span class="pagenum" id="Page_6">[6]</span>Throughout this division in particular, the analogies from +vegetables will be explained.</p> + +<p>III. In that part of the course which relates to the intellectual +organs and functions, will be explained the structure +and uses, <i>1st</i>, of the organs of sense which receive impressions +from external objects; <i>2dly</i>, of the brain, where +these impressions excite ideas; and, <i>3dly</i>, 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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_7">[7]</span>probable conclusions respecting the nature and the use of +each organ, or form of organ.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>The medical treatment of vegetables, which is almost +entirely surgical, would be equally benefited by these researches.</p> + +<p>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 +<span class="pagenum" id="Page_8">[8]</span>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.</p> + +<p>In considering the application, or rather the relation +of physiology to philosophy in general, the philosophy of +mind will be particularly dwelt upon.</p> + +<p>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.</p> + +<p>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.</p> + +<hr class="tb"> + +<p>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.</p> + +<p>Minerals have properly been said to exist, plants to +exist and live, animals to exist, live and think.</p> + +<p><span class="pagenum" id="Page_9">[9]</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<i>life</i> and <i>vital force</i> 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.</p> + +<p>For example, says Cuvier, let us contemplate a female +in the prime of youth and health,—that elegant voluptuous +<span class="pagenum" id="Page_10">[10]</span>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_11">[11]</span>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.</p> + +<p>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 +<span class="pagenum" id="Page_12">[12]</span>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.</p> + +<p>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 <i>were</i> 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.</p> + +<p>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.</p> + +<p>All the particles of matter possess attraction and repulsion, +and the largest homogeneous masses, <i>coeteris paribus</i>, +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 +<span class="pagenum" id="Page_13">[13]</span>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.</p> + +<p>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.</p> + +<p>Thus, it is, that I would endeavour to shew a connexion +between the phenomena of living bodies, and the general +laws of nature.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_14">[14]</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>These powers are always in an inverse relation to each +other.</p> + +<p>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, +<span class="pagenum" id="Page_15">[15]</span>that their aliment, in order to be conveniently digested, +must posses a composition analogous to that of their +organs.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_16">[16]</span>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.</p> + +<hr class="tb"> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_17">[17]</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>This also is more or less the case with plants. As +you descend among them, their parts become less dependent +<span class="pagenum" id="Page_18">[18]</span>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.</p> + +<p>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.</p> + +<p>Hence, I conclude, that sensation, understood in this +limited sense, as distinct from perception, and differing, +<i>toto coelo</i>, 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.</p> + +<p><span class="pagenum" id="Page_19">[19]</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_20">[20]</span>pervades all nature, and every natural operation illustrates +it.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_21">[21]</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_22">[22]</span></p> + +<hr class="chap x-ebookmaker-drop"> + +<div class="chapter"> + +<p><span class="pagenum" id="Page_23">[23]</span></p> + +<h2 class="nobreak" id="FIRST_PRELIMINARY_LECTURE"> +<span class="smaller">FIRST PRELIMINARY LECTURE<br> +<span class="smaller">TO THE COURSE OF</span></span><br> +PATHOLOGY AND<br> +THE PRACTICE OF MEDICINE;<br> +<span class="smaller"><span class="smaller">EXHIBITING</span><br> +THE OUTLINE OF A NATURAL SYSTEM OF<br> +PATHOLOGY, MEDICINE AND THE<br> +MATERIA MEDICA.</span></h2> + +</div> + +<p><span class="smcap">Gentlemen</span>,</p> + +<p class="first">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.</p> + +<p>“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 +<span class="pagenum" id="Page_24">[24]</span>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.”</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_25">[25]</span>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.</p> + +<hr class="tb"> + +<p>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.</p> + +<p>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.</p> + +<p>First, however, I shall proceed to exhibit the present +state of medical science.</p> + +<p>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 <i>distinctly</i>, 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.</p> + +<p>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 +<span class="pagenum" id="Page_26">[26]</span>them—the state of the capillary vessels. Considering its +extent, however, it was valuable.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_27">[27]</span></p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_28">[28]</span>consider the derangement of the mechanical, vital and intellectual +functions <i>distinctly</i>, 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.</p> + +<p>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.”</p> + +<p>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 +<span class="pagenum" id="Page_29">[29]</span>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.”</p> + +<p>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 +<span class="pagenum" id="Page_30">[30]</span>inquire not the perfect cures of many diseases, but, pronouncing +them incurable, do enact a law of neglect and +exempt ignorance from discredit.”</p> + +<p>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.</p> + +<hr class="tb"> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_31">[31]</span>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.</p> + +<p>I shall now, then, proceed to point out the mode of +obviating this state.</p> + +<hr class="tb"> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_32">[32]</span></p> + +<p>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.</p> + +<p>I shall now, therefore, restate these arrangements, +and then try their applicability to the medical art.</p> + +<hr class="tb"> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_33">[33]</span>by its being capable of instant adaption to physiological +science.</p> + +<p>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.</p> + +<p>Thus, the functions also are divided into mechanical, +vital and intellectual.</p> + +<p>The mechanical functions are subdivided into that of +support, that of connection and that of loco-motion.</p> + +<p>The vital functions are divided into that of absorption, +that of circulation and that of secretion.</p> + +<p>The intellectual functions are divided into that of sensation, +that of mental operation and that of volition.</p> + +<p>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.”</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>Those of the third class, as affecting the functions of +the organs of sense, of the brain and of the nerves, are +<span class="pagenum" id="Page_34">[34]</span>also three, viz. diseases of impression, diseases of judgment +and diseases of volition.</p> + +<p>The genera, under each order, consist of diminished, +irregular and increased function.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_35">[35]</span>each part the other, is and ought to be the true and brief +confutation and suppression of all the smaller sorts of objections.”</p> + +<p>I shall now, however, further explain the principles +upon which the natural system is constructed.</p> + +<hr class="tb"> + +<p>The correctness of this arrangement, as strictly founded +on physiology, is confirmed by the following observations.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_36">[36]</span>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.</p> + +<p>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 <i>change</i> 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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_37">[37]</span>which, as will be seen, exist between the animal, vegetable +and mineral worlds.</p> + +<p>Now, if disease consist in change of function, different +diseases must either consist in different changes of the +<i>same</i> function or in the changes of <i>different</i> functions; the +former, viz. different changes of the <i>same</i> 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.</p> + +<p>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.</p> + +<p>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, <i>fracture</i> is a disease of the mechanical +functions, <i>syphilis</i> of the vital functions, and <i>mania</i> +of the intellectual functions. With regard to the orders or +second and less general divisions of disease in the last of +these classes, <i>amaurosis</i> is a disease of impression or sensation, +<i>mania</i> of mental operation, and <i>paralysis</i> of expression +or volition. And with regard to the genera or subdivisions +of disease in the second of these orders, <i>fatuitas</i> is +a disease of diminished mental operation, <i>mania</i> of depraved +mental operation, and <i>vigilia</i> of increased mental operation. +Farther, with regard to the combination of disease under +<span class="pagenum" id="Page_38">[38]</span>the last class, (sleep itself consisting in the quiescence of +almost all the intellectual functions), <i>dreaming</i> consists +chiefly in the quiescence of sensation, <i>somnambulism</i> chiefly +in that of mental operation and <i>incubus</i> chiefly in that of +volition.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_39">[39]</span>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.</p> + +<p>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 <i>primarily</i> arranged. This last is one of the +most important consequences of such a system.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_40">[40]</span></p> + +<p>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.</p> + +<p>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).</p> + +<hr class="tb"> + +<p>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.</p> + +<p><span class="pagenum" id="Page_41">[41]</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_42">[42]</span></p> + +<hr class="chap x-ebookmaker-drop"> + +<div class="chapter"> + +<p><span class="pagenum" id="Page_43">[43]</span></p> + +<h2 class="nobreak" id="SECOND_PRELIMINARY_LECTURE"> +<span class="smaller">SECOND PRELIMINARY LECTURE<br> +<span class="smaller">TO THE COURSE OF</span></span><br> +PATHOLOGY AND<br> +THE PRACTICE OF MEDICINE;<br> +<span class="smaller"><span class="smaller">EXHIBITING</span><br> +A FUNDAMENTAL PRINCIPLE OF SURGICAL<br> +OPERATION.</span></h2> + +</div> + +<p><span class="smcap">Gentlemen</span>,</p> + +<p class="first">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.</p> + +<p>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 +<span class="pagenum" id="Page_44">[44]</span>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!</p> + +<p>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.</p> + +<p>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?</p> + +<p>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.</p> + +<hr class="tb"> + +<p>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 +<span class="pagenum" id="Page_45">[45]</span>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.</p> + +<hr class="tb"> + +<p>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>i. s.</i> 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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_46">[46]</span>of the body through any great nerve or vessel that is liable +to be the subject of surgical operation.</p> + +<p>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.</p> + +<p>These general principles excepted, other subordinate +rules are chiefly applicable to particular operations.</p> + +<hr class="tb"> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_47">[47]</span>light must fall directly downward from the head of the patient.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_48">[48]</span></p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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, +<span class="pagenum" id="Page_49">[49]</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>I shall now then state the objections which may be +urged against this principle.</p> + +<hr class="tb"> + +<p>It may be objected to the adoption of this fundamental +principle of all surgical operation.</p> + +<p><i>1st</i>, That the accidental and probable fracture of the +bone affording the fixed points, would, by deranging these +points, render all such measurement inapplicable.</p> + +<p><i>2d</i>, That varieties in the distribution of arteries, and +those deviations which are often produced by disease, would +have the same effect.</p> + +<p><span class="pagenum" id="Page_50">[50]</span></p> + +<p>I know not of any other objection that can be urged +against it, and these I shall immediately answer.</p> + +<hr class="tb"> + +<p><i>1st</i>, 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.</p> + +<p><i>2d</i>, 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 +<span class="pagenum" id="Page_51">[51]</span>the worst, will have to <i>calculate</i>, the latter will be unable +to do more than <i>guess</i>.</p> + +<p>Thus I have answered the only objections that it is +possible to urge against the principle proposed.</p> + +<p>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.</p> + +<p>I shall now deliver a short history of the method proposed.</p> + +<hr class="tb"> + +<p>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>i. s.</i> measurements from one point; +rarely proportional, <i>i. s.</i> 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.</p> + +<p>Precise or real proportional measurements between +fixed points, applicable to minute objects, <i>i. s.</i> such measurements +as I have proposed and described, never have +been, as far as I can discover, proposed and described before. +<span class="pagenum" id="Page_52">[52]</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<hr class="tb"> + +<p>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.</p> + +<p>A professor at an hospital in London, generally reckoned +one of the ablest surgeons of the metropolis, when +<span class="pagenum" id="Page_53">[53]</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>May the relation of these disgraceful occurrences, selected +from numerous similar ones, which, to my knowledge, +<span class="pagenum" id="Page_54">[54]</span>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.</p> + +<p>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.</p> + +<p>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.</p> + +<p>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 +<span class="pagenum" id="Page_55">[55]</span>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.⁠<a id="FNanchor_1_1" href="#Footnote_1_1" class="fnanchor">[1]</a>⁠</p> + +<div class="footnote"><p><a id="Footnote_1_1" href="#FNanchor_1_1" class="label">[1]</a> 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.</p> + +<p>“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 <i>those who are much occupied with dissection, +are but too apt to overrate the practical importance of a +minute knowledge of healthy structure</i>. That surgeon would +indeed justly hazard the imputation of rashness and presumption, +who would (<i>should</i> 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 <i>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</i>. 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.”</p> + +<p>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.</p> + +<p>When <i>I</i> have mistaken the femoral artery for the profunda; +when <i>I</i> have taken up arteries in amputation before sawing +off the bone; and when, in attempting to perform the operation +of Lithotomy, <i>I</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 <span class="smcap">the stone would +come away of itself</span>! 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.</p></div> + +<p><span class="pagenum" id="Page_56">[56]</span></p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_57">[57]</span></p> + +<hr class="tb"> + +<p>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.</p> + +<p>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.</p> + +<p><span class="pagenum" id="Page_58">[58]</span></p> + +<p>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.</p> + +<hr class="chap x-ebookmaker-drop"> + +<div class="chapter"> + +<p><span class="pagenum" id="Page_59">[59]</span></p> + +<h2 class="nobreak" id="POSTSCRIPT"><i>POSTSCRIPT.</i></h2> + +</div> + +<p>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, <i>although it was quite unconnected with the object +of the pamphlet in which it appeared</i>, 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 <i>short +distance</i>, that gentleman should influence attendance upon +their lectures, and lest a work so <i>widely diffused</i> over the +country should “encourage the rash and the ignorant to +sport, <i>by means of accurate measurements</i>, with the lives of +their fellow creatures, and entail disgrace and misery on +themselves....” <i>Humanity</i> 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 +<span class="pagenum" id="Page_60">[60]</span>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.</p> + +<p>What! M. Richerand, only at a thousand miles distance, +influencing the <i>newly organized</i> courses of lectures +in Edinburgh, and <i>two copies</i> of his dangerous book, proposing +precise measurements in surgery, <i>actually</i> 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, <i>in Edinburgh</i>, could +not have a thousandth part of the influence upon their lectures, +that M. Richerand could <i>at the distance of a thousand +miles</i>, and that my lectures, inculcating the principle <i>every +day</i>, could not have a millionth part of the tendency to +“encourage the rash and ignorant to sport, <i>by means of accurate +measurements</i>, with the lives of their fellow creatures +and entail disgrace and misery on themselves,” that <i>two copies</i> +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 +<i>therefore</i> could have no influence upon their lectures; I +was delivering these opinions every day, and they <i>therefore</i> +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 <i>therefore</i> must have great influence +upon their lectures; of his book even two copies are in the +British empire and its sentiments <i>consequently</i> must be most +widely disseminated; and it was <i>well contrived</i> and <i>inexpressibly +humane</i> to introduce and firmly to oppose such a +<i>desperate</i> character, even in a work upon a <i>different subject</i>. +In short, these gentlemen had the nearest interest in opposing +<span class="pagenum" id="Page_61">[61]</span>him.... Well, it must certainly be highly satisfactory +to have thus opposed the progress of error and rescued +the human race from <i>disgrace</i> and <i>misery</i>. Generous, disinterested, +philanthropic defenders of <i>humanity</i>, you have +your reward <i>in your own breasts</i>.</p> + +<p>But their apology will not bear the test of ridicule. +Let us therefore examine, in another way, the foundation +upon which it rests.</p> + +<p>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, <i>even since I first enunciated the principle</i>, 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 <i>failed</i>; whereas the proposition +enunciated by me has been tried, has <i>uniformly succeeded</i>, +and, such is its correctness, that it constitutes the basis of +that part of my course which involves the operations of +<span class="pagenum" id="Page_62">[62]</span>surgery. Therefore, even according to themselves, <i>the +propositions cannot be the same</i>.</p> + +<p>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.</p> + +<hr class="tb"> + +<p>Mr <span class="smcap">Walker’s</span> Course of <span class="smcap">Anatomy</span> and <span class="smcap">Physiology</span> +recommences on <i>Tuesday the 8th of November, at</i> <span class="smcap">eleven +o’clock</span>, a. m. and his Course of <span class="smcap">Pathology</span> and the +<span class="smcap">Practice of Medicine</span>, at <span class="smcap">two o’clock</span>, p. m. and will +be continued daily at these hours, at No. 63, SOUTH +BRIDGE-STREET.</p> +<div style='text-align:center'>*** END OF THE PROJECT GUTENBERG EBOOK 78678 ***</div> +</body> +</html> diff --git a/78678-h/images/cover.jpg b/78678-h/images/cover.jpg Binary files differnew file mode 100644 index 0000000..a09d381 --- /dev/null +++ b/78678-h/images/cover.jpg |
