Part 5

To obviate these important defects is the very object of the present lectures.—I shall assiduously study to supply all of them; I shall, after delivering a natural system of medical science in general, the tendency of which is not to controvert one established fact, but by pointing out their relations, to consolidate, to simplify and if possible to increase the amount of our knowledge on all the subjects of medicine—I shall, I say, after this, enter into all its details, point out the relative situation of those parts which perpetually come under the care of the surgeon, explain all the variety, of the applications of an original, fundamental and universally applicable principle of surgical operation, and endeavour to direct the student, while, with his own hand, he performs each of these operations.

Public bodies, Gentlemen, as well as individuals, have too often opposed the progress of science.... But, when have they been able to impede it?—Never. The iron grasp of tyranny and the intrigues of malice are alike innocuous to truth; the progress of science is irresistible and triumphant.

On the present occasion, I feel it my duty to propose a new system, nor do I expect very different treatment; for though the gun of the soldier and the anathema of the priest be no longer connected, the malice of the interested and the intrigues of party occupy their place: the former were the measures of a barbarous; the last are those of a half-polished age. Fortunately, however, far from being formed to fear opposition—I court it.

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The following sketch of a natural system of medical science is founded on the strict basis of physiology, and is, I trust, calculated to place, in a new and more interesting point of view, the beautiful relations which subsist between the sciences of anatomy and physiology and the art of medicine, as well as to lay the foundation of a more rational system of medical science.

I do not, however, make this statement without a feeling of the utmost deference to the labours of the celebrated Cullen and Brown—the authors of the existing systems and of innumerable observations of the highest value in medical science. Nothing less than the firmest conviction of the truth and simplicity of the system I am about to propose, could have induced me to deliver it.

First, however, I shall proceed to exhibit the present state of medical science.

No system of the medical art can be just in its principles, and perfect in its application, which does not consider the derangement of the mechanical, vital, and intellectual functions distinctly, and trace each disease to the operation of its cause in the derangement of that particular function which was first produced, and which led to the derangement of all the rest.

It has been the fate of all systems to be founded upon partial views of the functions. The system of the celebrated Cullen, for example, was founded merely upon the vital functions, and even upon a very limited portion of them—the state of the capillary vessels. Considering its extent, however, it was valuable.

The system of Brown, likewise, was similarly founded merely upon the state of the intellectual or nervous functions. That system, therefore, although worthy of consideration, is not founded upon a view of all the animal functions, and consequently does not rationally account for all their derangements in disease. The basis of its author’s discovery was his mistaking the mere elasticity or reaction of matter for a peculiar property of living bodies, which he termed excitability. For excitability, when it seems to have been exhausted, is apparently restored by still stronger stimuli, upon the very same principle that greater pressure brings into action the remaining elasticity of a spring which had already lost some portion of it.

But what is worse, Brown totally forgot that matter has other properties, and that the constitution of animals admits of other derangements than those affecting their elasticity or their excitability. Extension, for instance, another property of matter, may be destroyed in the living body, by fracture, rupture, &c.; and there evidently it is not excitement that is first produced, or that is worthy either of the first or of the greatest consideration. Brown’s doctrine, then, refers chiefly to the state of the nervous functions. Its chief merit is, that it involves a great portion of their pathology. It is because it does so, that men of ingenuity have often embraced it; and it is in reality because it did not do more—because it did not involve the pathology of the other two classes of functions, that men of much observation opposed it; and that even many of those men of genius who, throughout Europe, had adopted it, were afterwards forced, they scarce knew why, to abandon it.

Certainly, in all diseases, the nervous functions must be affected; but they may be affected through the vital or mechanical functions—by means, for instance, of an aneurism or a fracture. A fracture or an aneurism, however, have no existence as diseases under the Brownonian system. These are whimsically, absurdly, termed stimuli; not diseases, but mere causes of disease; and the attention of the physician is, upon the principles of that hypothesis, ridiculously turned from the immediate disease to others depending upon it, to the state of the nervous functions. And for what purpose? Not, by their aid, as mere accessary and subordinate considerations, which in this case they really are, to regulate the disease of the mechanical or vital functions, from the very first the most obvious, but in order to discover the very existence of any disease; as if fracture or aneurism in themselves were not alarming diseases, independently of their effects upon other parts of the system, as if the injury done to the mechanical functions, to loco-motion, was less worthy the name of disease than that done to the intellectual functions, to nervous motion. Yet, in practice, the Brownonian, even supposing that the nervous system were little or not at all affected, would instantly abandon his hypothesis, and demonstrate its inapplicability, by recurring to the injury of the mechanical functions, by setting the fractured limb, or operating for the aneurism. In the first of these instances, indeed, the primary disease, almost the only one worthy of consideration, is the injury done to the mechanical functions, to loco-motion, which has absolutely nothing to do with excitability or excitement.

It is not my view, however, intirely to exclude these systems, or to depreciate their real value, but to show that they merely form portions of a natural system. Still no system of the medical art can be perfect, which does not consider the derangement of the mechanical, vital and intellectual functions distinctly, and enable us to trace each disease to the operation of its cause in the derangement of that particular function, whether mechanical, vital, or intellectual, which was first produced, and which led to the derangement of all the rest.

These opinions I may support by the observations of others. “Efforts laborieux et multipliés,” says Pinel, “de Sauvages, Cullen, Sagar, Vogel, Linné, Nietzki, Selle, Van-Denheuvell, &c. pour distribuer toutes les maladies connues en classes, en ordres, en genres, en especes, à l’exemple des botanistes, et toujours pour résultat une extrême surcharge du tableau, une classification a bitraire et vaccillante, des affections symptomatiques prises pour des maladies primitives, une multiplication excessive, des unes et des autres par des complications sans nombre des maladies, une sorte d’impossibilité avouée d’obtenir un ensemble régulier qui ne porte que sur quelques points fondamentaux, et qui vienne se placer sans efforts et sans confusion dans la memoire.”

I cannot better explain my opinion of the present state of medicine than by using, respecting it, the language of Lord Bacon, which is, at this moment, as applicable to it, as it was when first written. “We see,” says he, “the weakness and credulity of men is such, as they will often prefer a mountebank or witch, before a learned physician, and, therefore, the poets were clear-sighted in discerning this extreme folly when they made Æsculapius and Circe, brother and sister, both children of the sun.—For, in all times, in the opinion of the multitude, witches, and old women, and impostors have had a competition with physicians. And, what followeth? Even this; that physicians say to themselves, as Solomon expresseth it upon an higher occasion, If it befall to me as it befalleth to the fools, why should I labour to be wise? And, therefore, I cannot much blame physicians, that they use commonly to intend some other art or practice which they study more than their own profession. For, you shall have of them, antiquaries, poets, humanists, statesmen, merchants, divines, and in every of these better seen than in their own profession; and, no doubt, upon this ground, that they find that mediocrity and and excellence in their art maketh no difference in profit or reputation toward their fortune; for the weakness of patients and sweetness of life, and nature of hope, maketh men depend upon physicians with all their defects.”

But Lord Bacon has assigned an amply sufficient reason for these circumstances. In another place, he says, “Medicine is a science which hath been, as we have said, more professed than laboured, and yet more laboured than advanced, this labour having been in my judgment, rather in circle than in progression. For I find much iteration, but small addition.” Now it is, in reality, this profession without labour, this labour without advancement, so well expressed by Lord Bacon, this iteration without addition, which is the real and sufficient cause (overlooked by him) of the poets so properly making Æsculapius and Circe, brother and sister, and of the world uniformly placing witches, old women and impostors in competition with physicians. And again his lordship, with equal justice, says, “in the inquiry of diseases, they do abandon the cures of many, some as in their nature incurable, and others as past the period of cure; so that Sylla and the triumvirs never proscribed so many men to die, as they do by their ignorant edicts, whereof numbers do escape with more difficulty, than they did in the Roman proscriptions. Therefore I will not doubt to note as a deficience, that they inquire not the perfect cures of many diseases, but, pronouncing them incurable, do enact a law of neglect and exempt ignorance from discredit.”

It therefore becomes proper to ascend to the cause of the little success which has hitherto attended medical investigation, and to attempt, by the removal of that cause, to accelerate its progress, and, by increasing the success, to increase the respectability of the art.

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The grand cause which has hitherto retarded the progress of medicine, has been the total want of a general principle, and this want has arisen from the very low state of physiological theory.

It has ever appeared to me that a sufficient distinction has not been made between diseases as affecting various functions, which to the most superficial observer seem to be very different in their nature. It would appear, at first sight, that, instead of almost uniformly applying mental remedies to mental diseases, the physician not only does not distinguish what stages and parts of the same disease are mechanical, what vital and what intellectual, which must uniformly be the case where all the functions are involved, but that he does clearly perceive such a distinction at all to subsist in any form or combination of disease.

The physician has also failed to attend to a correct arrangement of the various articles of the materia medica, which ought not to be considered merely as stimulant, sedative, &c. but as in reality operating upon different functions.

Besides these, there appear to be other subordinate objects of inquiry, which he has hitherto, to a certain extent, overlooked; namely, that medicines seem to be objectionable from the injury which they do to those functions which are the vehicles of their operation, the uncertainty also of their effects as influenced by association, the uncertainty of their continuance as dependent on the same and other causes, the difficulty of removing their bad effects, and the injury they do to the intellectual functions in making man entirely the creature of direct impression instead of reflection.

I shall now, then, proceed to point out the mode of obviating this state.

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These seem to me to be points eminently worthy of consideration, and the best mode of obviating the objections they involve, is a greater attention to natural theory and arrangement.

But, in order perfectly to remedy these great defects, the cultivation of physiology is primarily necessary. As far as the accumulation of facts goes, it has, however, already been cultivated, and that most assiduously. But before these accumulated facts can afford a principle of medicine, they must afford a theory of physiology, and, before they can afford this, they must be arranged according to their relations to each other.

I may here observe, that the sciences alone afford theories, the arts admit merely of principles upon which these reasonings or theories are applied to the wants of man. Thus, in every step of their progress, the arts must implicitly depend upon the sciences.

Now medicine is purely an art and admits of a principle derived from physiology by which the theories of that science may be applied to the cure of diseases.