Part 7

The action, for instance, of vessels in absorbing, circulating and secreting, so far as, in vegetables, for instance, the form and arrangement of their capillary tubes are concerned, or the continuation of the action commenced in these tubes, or the effusion of their contents when ruptured, is evidently independent of nerves; and I believe, were this principle traced further, it would be found to account for many of the actions of animal as well as vegetable parts. Whether true or false, however, it cannot materially affect the system. For whether their action is dependent on nerves or not, it is, strictly speaking, their own action, and, by injury, they are rendered incapable of performing it.

Disease may thus properly be defined, any change of the healthy state and healthy function of parts. If any one urge, that disease implies the action, not the state of parts, I grant it; but must observe that change of state is action, and change of healthy state is evidently morbid action or disease, whether it arises from within or without, whether suddenly from external and accidental causes, or more slowly within the body and in dependence upon other previous derangement.

Indeed to trace any disease back through previous derangement is actually to trace out other diseases, and to define any disease from others thus traced out, is to abandon those distinctions which separate the termination of one disease from the commencement of another.

If any one still assert, that disease is not change of the state but change of the action of parts, and urge that those accidents which depend on external causes, as fracture, considered in themselves, are not disease, I should say, were this even proved, it could only affect my arrangement by giving the term injuries, instead of diseases, to the first class. As, however, it seems to me that they may justly be named diseases, and that practically considered they are precisely the same, I shall retain that term. Thus, we shall have a fairer view of the interesting analogies which, as will be seen, exist between the animal, vegetable and mineral worlds.

Now, if disease consist in change of function, different diseases must either consist in different changes of the same function or in the changes of different functions; the former, viz. different changes of the same function, as being a more minute division, making evidently the genera which are subordinate; the latter, viz. changes of different functions, as being more general, forming the orders which include these genera.

From the inspection of the table, and a consideration of the nature of disease, it will appear, that whatever is commonly reckoned one disease, is generally, perhaps always, three; thus fracture is always accompanied by inflammation and pain; and while the simple fracture is a disease of diminished support, the inflammation caused by it is a disease of increased circulation, and the pain caused by it a disease of increased impression.

As individual diseases are not arranged under the table, I may, in order to render my meaning perfectly obvious, give one or two examples of this mode of classification. Thus with regard to the classes or first and most general divisions of disease, fracture is a disease of the mechanical functions, syphilis of the vital functions, and mania of the intellectual functions. With regard to the orders or second and less general divisions of disease in the last of these classes, amaurosis is a disease of impression or sensation, mania of mental operation, and paralysis of expression or volition. And with regard to the genera or subdivisions of disease in the second of these orders, fatuitas is a disease of diminished mental operation, mania of depraved mental operation, and vigilia of increased mental operation. Farther, with regard to the combination of disease under the last class, (sleep itself consisting in the quiescence of almost all the intellectual functions), dreaming consists chiefly in the quiescence of sensation, somnambulism chiefly in that of mental operation and incubus chiefly in that of volition.

With regard to the articles of the materia medica, or rather with regard either to external or internal applications, the correctness of my arrangement, as indicating their influence upon the different classes of organs, will, on the slightest consideration, appear equally evident; pressure, for instance, affects the mechanical, mercury the vital and opium the intellectual system. But, like the diseases which they remedy, it will appear, that each of these also affects all of the functions, though in a less direct manner than that which I have just now particularly pointed out as its object, and upon which the exact place of each in a systematic arrangement ought to depend.

It cannot, therefore, be a just objection to this arrangement, that it throws each of what are commonly called diseases under these different classes, as, in reality, each of the common diseases is more properly three, and exists under three natural classes. Even in this way, does every physician, though unaware of it, consider them, and therefore, instead of giving any new complexity to nosology, it merely explains and simplifies that complexity which ever has existed in the nature of disease. In other words, it is natural, and developes and simplifies only the combinations of nature.

Thus, no one disease, properly so called, can, with the slightest truth, be said to fall under three different classes, as inflammatory and suppurative phthysis, which are even commonly reckoned distinct stages, or as fracture, inflammation, &c. which are essentially different in their nature and may actually be combined in every possible form. Thus it can serve no useful purpose to reckon them one disease, while it destroys every natural arrangement and all the invaluable consequences dependent on it, and absolutely leads first to confusion, next to false reasoning and then to the most fatal errors in actual practice.

Although, however, nosology must thus, in any thing like a natural arrangement, be fixed most accurately upon the basis of physiology, the classification of every disease may be derived from the particular derangement of that individual function which occasions the derangement of all the rest, and not from the derangement of all the three functions which would render names uselessly complex.—I say uselessly, because, as the whole of any one disease, commonly so termed, is primarily dependent on the derangement of one function, so health is to be recovered chiefly by the restoration of that function, and the mode of cure is chiefly indicated by the name of genus under which the disease is primarily arranged. This last is one of the most important consequences of such a system.

If, however, the names of diseases and their classification are not thus made dependent most strictly on each specific change from the healthy state described in physiology, they are at once arbitrary and unnatural; the pathology and nosology of which they constitute a part, have not their foundation in physiology, nor is the practice constructed upon them indicated by the reasonings it delivers.

To reckon a series of occurrences which entirely differ in their nature, consequences and mode of cure, as one disease, may serve the purposes of common language, but by no means those of medical science and medical arrangement.

In considering the natural arrangement of medical science exhibited above, it will be particularly necessary to avoid substituting the term “organ” for “function.” The term “diseases of organs” expresses merely the seats of disease, whilst the term “diseases of functions” expresses their nature. Nevertheless a reference may also be made to the various organs, as it is evident that there may be disease of the vital or any other function in a mechanical organ. Thus a tumour in a bone is a disease of secretion, or an ulcer in a similar situation a disease of absorption; both being orders of the class—Diseases of the vital functions.

The first principle of the medical art, therefore, is founded upon a knowledge of the relations subsisting between the various states of the animal functions and the power of medicines, as exhibited in the preceding sketch of a natural system; and it consists in the application of the articles of the different genera of medicines (exhibited in the last column of the table) to the cure of the corresponding genera of disease (exhibited in the third one).

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One of the most beautiful results of the principle I have proposed is, that, by its adoption, it will be possible for the physician to lay his hand upon the several columns of a table, each of which, with regard to the diseases which it enumerates, is precisely similar in its nature from commencement to end; indicates correspondingly arranged articles of the materia medica, and requires precisely a similar mode of cure.

As the same arrangement is applied to the articles of the materia medica, the corresponding medicine will evidently, in every case, readily present itself to him.

But the most signal advantage resulting from it is, that, by merely assigning to any disease its place in nosology, the physician will instantly indicate the mode of cure which ought to be adopted for it.

I shall now then, Gentlemen, conclude by this important remark, that happily the tendency of this natural system of disease is not to controvert one established fact, but, by pointing out their relations, to simplify, consolidate and if possible to increase the amount of our knowledge on all the subjects of medicine.

SECOND PRELIMINARY LECTURE TO THE COURSE OF PATHOLOGY AND THE PRACTICE OF MEDICINE; EXHIBITING A FUNDAMENTAL PRINCIPLE OF SURGICAL OPERATION.

GENTLEMEN,

The vague plans of Surgical operation, at present practised, are too generally known, and too sincerely deplored, by every man of science and of feeling, to demand much of comment on the present occasion.

How often, in the attempt to take up an artery, does the ignorant and timid operator make an incision so limited that he is afterwards forced cruelly to extend it! How often, having extended his incision, does he find no artery beneath it, and dig or mine for it in a new direction, by cutting up the flesh of the patient! How often, having reached the place he sought for, does he mistake another artery, a nerve, or even a vein, for that which ought to be the subject of operation! How often, having found the artery, is he at a loss to recognize it! What trepidation and alarms does not this operator, more miserable than the patient himself, endure!

I know no situation more wretched or more pitiable than this. Here, even at the best, the most exquisite torture is inflicted: the poor trembling patient, abstracted from every other earthly object, and with the most exquisite feelings concentrated on the present, awaits, in awful suspence, the impending stroke which is to divide the skin, that seat of accumulated sensibility, and deliver him from wretchedness; but the hope is vain, his torments are again and again renewed; he perceives that his life is the sport of a fool; he writhes in agony, or sinks in deliquium; and the issue is, as might be expected, too generally, even at the best, unsuccessful.

When all this is not the case, how often does the operator, on the contrary ignorant and rash, plunge his knife into some vital organ of the patient, and at once terminate his life and his diseases?

That this picture is not too highly coloured, I solemnly appeal to the conscience and the feelings even of the best operators, who are too candid to deny that melancholy reflection has often oppressed them from the fate of patients—martyrs to their want of precision.

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