The Project Gutenberg eBook of Outline of a natural system of medical science
    
This eBook is for the use of anyone anywhere in the United States and
most other parts of the world at no cost and with almost no restrictions
whatsoever. You may copy it, give it away or re-use it under the terms
of the Project Gutenberg License included with this eBook or online
at www.gutenberg.org. If you are not located in the United States,
you will have to check the laws of the country where you are located
before using this eBook.

Title: Outline of a natural system of medical science
        Forming the preliminary lectures to two courses: one on anatomy and physiology; the other on pathology and the practice of medicine

Author: Alexander Walker


        
Release date: May 13, 2026 [eBook #78678]

Language: English

Original publication: Edinburgh: "university press" (see note), 1808

Other information and formats: www.gutenberg.org/ebooks/78678

Credits: Jamie Brydone-Jack and the Online Distributed Proofreading Team at https://www.pgdp.net (This file was produced from images generously made available by The Internet Archive)


*** START OF THE PROJECT GUTENBERG EBOOK OUTLINE OF A NATURAL SYSTEM OF MEDICAL SCIENCE ***




OUTLINE OF A NATURAL SYSTEM OF MEDICAL SCIENCE.




                                  OUTLINE
                                   OF A
                              NATURAL SYSTEM
                                    OF
                             MEDICAL SCIENCE.

                  FORMING THE PRELIMINARY LECTURES TO TWO
                  COURSES: ONE ON ANATOMY AND PHYSIOLOGY;
                      THE OTHER ON PATHOLOGY AND THE
                           PRACTICE OF MEDICINE.

                         BY ALEXANDER WALKER, ESQ.
                       LECTURER ON PHYSIOLOGY, ETC.
               EDITOR OF THE ARCHIVES OF UNIVERSAL SCIENCE,
                                  &c. &c.

    _By pronouncing diseases incurable, physicians have attempted
    to enact a law of neglect, and to exempt ignorance from
    discredit_.

                                                         LORD BACON.

                                EDINBURGH:
                     PRINTED AT THE UNIVERSITY PRESS.
              FOR SIR RICHARD PHILLIPS, NO. 6, BRIDGE-STREET,
                         BLACKFRIARS, LONDON, AND
                 MESSRS T. BRYCE AND CO. INFIRMARY-STREET,
                                EDINBURGH.
                                   1808.




TO

ALEXANDER MONRO, ESQ. SENIOR,

_M. D. Professor of Medicine, Anatomy and Surgery, in the University of
Edinburgh, &c._


This Outline of a Natural System of Medical Science is most respectfully
dedicated by one who is grateful for the benefits he has conferred upon
Anatomy and Physiology, and who is desirous of following his footsteps in
the cultivation of these Sciences.

                                                         ALEXANDER WALKER.

    _2, North College Street,
        27th October 1808._




ADVERTISEMENT.


_In this small Work, the Author has delivered a very brief Outline of
a Natural Systematic Arrangement and Theory of Anatomy, Physiology,
Pathology and of the Materia Medica, as strictly dependent on each other._

_Of this system the tendency is, not to controvert one established fact
of Medical Science, but by pointing out their relations, to simplify, to
consolidate and if possible to increase the amount of our knowledge in
all the departments of Medicine._

_As a work of this kind is a fair object of criticism; to the philosophic
and liberal reviewer I have only to say, that I shall most willingly
submit to his decision. Error is almost inseparable from propositions of
any extent or magnitude, and I have doubtless committed many. But to the
reviewers for the Edinburgh Medical and Surgical Journal, and those of a
London Review under their influence, as they constitute a party somewhat
in opposition to my views, I have to observe, that, should they act
unjustly, as I know them not individually, I must hold their editor, whom
I do know, responsible for their conduct, and I consequently shall do so._




PRELIMINARY LECTURE TO THE COURSE OF ANATOMY AND PHYSIOLOGY; EXHIBITING
THE OUTLINE OF A NATURAL SYSTEM OF THESE SCIENCES.


GENTLEMEN,

The functions of man are the most interesting objects of Science. Physics
and Morals are equally involved by them. It is in them that the physical
sciences terminate, and that the moral sciences have their origin.

Of what avail are the former, but to develope the influence of external
bodies upon the functions of man? What are the latter, but the results of
the reaction of that influence upon men in society?

To explain them is the business of physiology; and if it have hitherto
failed in doing so—if it have even neglected the noblest of all the
functions—I should say the noblest branch of philosophy—the intellectual
functions of man, and have abandoned them to persons totally incapable of
developing them, because totally ignorant of the structure on which they
depend, and who have left them in a state of greater obscurity than that
in which they found them, that is the fault of physiologists, and not of
their science.

In these lectures, I shall at least be influenced by the deepest sense of
such errors.

But it is not merely the philosophy of the human mind, or rather of
the intellectual functions of man, that have thus been abandoned to
barbarism. The science itself has never been systematized; and all its
individual parts have been so neglected, that the other sciences and the
arts dependent upon it, have been left in similar obscurity.

I shall endeavour to shew that it is by the aid of physiology alone that,
in explaining the functions of the eye, for instance, we can render
perfect the theories of colour and of vision; that, in explaining the
functions of the ear, we can construct rational ones of phonics and of
hearing; that in explaining the functions of the organ of voice, we
can illustrate the formation of letters, and the origin of languages;
that, in explaining the functions of the muscles, we can establish those
first principles of taste in the fine arts, the very existence of which
have so often been questioned, and so deliver a theory of movement and
of attitude, applicable to sculpture, the higher species of painting,
gesture in oratory, &c. In fine, it is by physiological means only,
that we can construct a natural theory of medicine, and render precise
and easy, the most delicate and the most difficult of the operations of
surgery.

To effect these purposes, nothing is more necessary than arrangement,
because it at once involves facts and their theory, or the reasonings
founded upon them.

       *       *       *       *       *

In considering a natural arrangement of Anatomy and Physiology, it
appears to me an unquestionable point, that it ought to indicate, at a
single glance, the relation of all the functions to and their dependence
upon each other.

It is upon this principle that I have constructed the natural arrangement
which I am about to detail; and a single remark upon the arrangements
adopted by the most celebrated modern physiologists, will, at once, shew
the originality of the plan which I propose, and point out the errors of
arrangement which I deprecate.

Blumenbach, Chausier, Dumas and Bichat, treat of circulation before
absorption, on which it depends, and even before mastication, deglutition
and digestion, on which, in general, even absorption itself chiefly
depends.

If the arrangement of Chausier in particular, who, in this respect, is as
accurate as any of them, were to be considered as indicating the relation
and dependence of the functions, so absurd is it, that absorption instead
of the cause, would be the result of nutrition, generation the result of
absorption, and digestion the result of generation. Thus, by arranging
effects in the place of causes, they confound the relations of the
functions, and reverse the very order of their dependence.

The division of the functions into external and internal, as anciently
proposed by Aristotle, and afterwards successively adopted and improved
by Buffon, Grimaud and Bichat (the last of whom substituted for them the
terms organic and animal) is still more faulty.

Anatomy, I divide into three parts, namely that which considers the
mechanical or loco-motive organs, that which considers the vital organs,
and that which considers the intellectual organs.

Under the mechanical or loco-motive organs, I class, first, the bones
which support the rest of the animal structure; second, the ligaments
which unite them; and third, the muscles which move them.

Under the vital organs, I class, first, the organs of digestion, the
absorbent surfaces, and the vessels which absorb from these surfaces;
second, the heart, lungs and blood-vessels, which derive their contents
(the blood) from the absorbed lymph; and third, the organs of secretion,
which separate various matters from the blood. Then follow the generative
organs, which, though generally formed into a distinct class from the
vital, ought not by any means to be so reckoned. For it is evident, that
they form, as it were, the sequel of the vital organs, being dependent
on secretion—the last of the vital functions, and destined merely to
propagate vitality, and to communicate it to a new series of beings.

Under the intellectual organs, I class, first, the organs of sense, where
impressions take place; second, the brain or organ of judgment, where
these excite ideas; and third, the nerves, where volition results from
the last.

This is a natural arrangement of the anatomy of animals, and its peculiar
simplicity is illustrated by its involving, in application, that of
minerals and vegetables, and by its being capable of instant adaption to
physiological science.

In order to arrange Animal Physiology, it is only necessary to substitute
the term “functions” for “organs;” and that science will likewise
involve, in application, the physiology of mineral and vegetable bodies,
and be, in its turn, capable of instant adaption to medical science.

Thus, the functions also are divided into Mechanical, Vital and
Intellectual.

The mechanical functions are subdivided into that of support, that of
connection, and that of loco-motion.

The vital functions are divided into that of absorption, that of
circulation, and that of secretion.

The intellectual functions are divided into that of sensation, that of
mental operation, and that of volition.

A circle of functions, I may observe, thus exists in animals, which
exists not in minerals or vegetables, because volition, the last of
the intellectual functions, connects itself to the mechanical ones, by
rendering them subservient to it in loco-motion. Thus the first and
the last of these functions are as intimately connected as any of the
intermediate ones, and a beautiful circle of organic function and organic
influence is formed.

The plan of the course will, therefore, be precisely the same with that
which I have proposed for Anatomy and Physiology in general.

I. In that part of the course which relates to the mechanical organs and
functions, will be explained the structure and uses, _1st_, of the bones
which support the rest of the animal machine; _2dly_, of the ligaments
which unite it; and _3dly_, of the muscles which move it.

II. In the first part of the course which relates to the vital organs and
functions, will be explained the structure and uses, _1st_, of the organs
of mastication, deglutition and digestion, of the absorbent surfaces,
and of the vessels which absorb from these surfaces; _2dly_, of the
heart, lungs and blood-vessels, which derive their contents, (the blood),
from the absorbed lymph; and, _3dly_, of the organs of secretion, which
separate various matters from the blood. Throughout this division in
particular, the analogies from vegetables will be explained.

III. In that part of the course which relates to the intellectual organs
and functions, will be explained the structure and uses, _1st_, of the
organs of sense which receive impressions from external objects; _2dly_,
of the brain, where these impressions excite ideas; and, _3dly_, of the
spinal marrow and nerves, where volition results from the last. In this
division, will be also explained, as founded upon original observations,
certain criteria of the various degrees of the sensitive, perceptive and
voluntary powers possessed by different animals, as well as the nature of
sensation, perception and volition themselves.

As in physiological enquiries, comparative anatomy and comparative views
alone can destroy an hypothesis or transmute it into a theory, I shall
throughout the course introduce all its principal facts.

The machines, says Cuvier, which are the object of our researches, cannot
be demonstrated without being destroyed. We have no means of discovering
what would result from the absence of one or several of their parts, and
consequently we remain ignorant of the operation of each of these parts
in producing the total effect.

Fortunately, nature herself seems to have prepared for us the means of
supplying that want which arises from the impossibility of making certain
experiments on living bodies. The different classes of animals exhibit
almost all the possible combinations of organs. We find them united, two
and two, three and three, and in all proportions; while at the same time
it may be said that there is no organ of which some class or some genus
is not deprived. A careful examination of the effects which result from
these unions and privations is therefore sufficient to enable us to form
probable conclusions respecting the nature and the use of each organ, or
form of organ.

In the same manner, we may proceed to ascertain the use of the different
parts of the same organ, and to discover those which are essential, and
separate them from those which are only accessary. It is sufficient
to trace the organ through all the classes which possess it, and to
examine what parts constantly exist, and what change is produced in the
respective functions of that organ, by the absence of those parts which
are wanting in certain classes.

Thus, says Richerand, the cellular structure of the lungs which cannot be
clearly demonstrated in man, on account of the excessive tenuity of their
smallest lobuli, evidently displays itself in the vesicular lungs of
salamanders and frogs; in the same manner, the scales covering the bodies
of fish and reptiles, or the claws of birds, give us a just idea of the
structure of the epidermis, and of the disposition of its small laminæ
that are laid over each other on a part of their surface, &c.

Vegetable life, justly, says the same author, compared in its resources
and effects with animal life, would throw very great light on several
phenomena, which, at present, it is difficult for us to conceive and to
explain.

The medical treatment of vegetables, which is almost entirely surgical,
would be equally benefited by these researches.

Thus the wounds of vegetables, like those of the human body, are much
less dangerous when their surface is smooth, than when their edges
are rough, lacerated, or contused. Trees cut down with a saw bud with
difficulty, whilst those felled with an axe vegetate more briskly.—The
saw tears the vegetable structure and produces a greater or less
alteration in organization. The unequal surface of a tree thus cut down
retains humidity, as destructive to the trunk, of which it induces a
rottenness, as too great a quantity of pus, that so habitually moistens
the surface of an animal wound, destroys granulation and prevents
cicatrization.

In considering the application, or rather the relation of physiology to
philosophy in general, the philosophy of mind will be particularly dwelt
upon.

In considering the application of physiology to the fine arts, the error
in the construction of the antique statues, and of those of Michael
Angelo, both with regard to the individual muscles supposed to be brought
into action, and with regard to a hitherto unobserved principle of
attitude, will be carefully pointed out.

In considering the application of physiology to the medical and
surgical arts, a view of a new, simple and impressive natural system
of medical science in general, and of its first principles as an art,
will be exhibited; and rules will also be given for performing surgical
operations with the utmost precision and ease, upon the principle of
an invariable relation between the arrangement of internal, and the
situation of certain external parts, which consequently form accurate
signs of that arrangement.

       *       *       *       *       *

I may now observe, that the series of beings which the arrangement I have
just delivered involves, all more or less evidence the phenomena of life
and intellect, as well as exhibit structure, and I may conclude with a
few observations concerning these phenomena.

Minerals have properly been said to exist, plants to exist and live,
animals to exist, live and think.

These are all modifications of each other, as I shall afterwards shew;
but, at present, I shall limit my observations to the two last of these
classes, and to the additional phenomena, namely those of life and
intellect, which they more strikingly exhibit.

I shall not, however, like some of the most celebrated modern
physiologists, occupy my preliminary lectures with long details
concerning their nature; but, as I reckon life to be the mere result of
organization, I shall, throughout the course, illustrate it in connexion
with those organs on which it depends, and shall, at present, only take a
general view of its nature.

Life is a term which some philosophers have hitherto inaccurately
employed as expressing an imaginary principle, though it merely
designates a series of dependent actions. This they were doubtless
induced to do by that artifice which has ever induced weak men to assume
an air of knowledge by giving a particular name to what they did not
understand; and the same artifice still induces such persons to blame
those who endeavour to explain the phenomena of life according to obvious
physical laws, precisely because a successful explanation would at once
exhibit their ignorance and their desire to conceal it.

Life has, with equal absurdity, been termed a forced state, though it
merely evinces a series of phenomena in justest unison with those of the
universe. I dissent, therefore, from those who assert, that we employ the
terms _life_ and _vital force_ to express what are apparent exceptions to
general laws. This is only a repetition of the error of Brown. It was,
however, an erroneous conclusion from accurate observations.

For example, says Cuvier, let us contemplate a female in the prime of
youth and health,—that elegant voluptuous form—that graceful flexibility
of motion—that gentle warmth—those cheeks crimsoned with the roses of
delight—those brilliant eyes, darting rays of love, or sparkling with the
fire of genius—that countenance enlivened by sallies of wit, or animated
by the glow of passion, seem all united to form a most fascinating being.
A moment is sufficient to destroy this illusion. Motion and sense often
cease without any apparent cause; the body loses its heat; the muscles
become flat; and the angular prominences of the bones appear; the lustre
of the eye is gone; the cheeks and lips are livid.... These, however,
are but preludes of change still more horrible. The flesh becomes
successively blue, green and black. It attracts humidity; and while one
portion evaporates in infectious emanations, another dissolves into a
putrid sanies, which is also speedily dissipated. In a word, after a
few short days, there remains only a small number of earthy and saline
principles. The other elements are dispersed in air and in water to enter
again into new combinations.

This, Cuvier adduces as a proof that the possession of life prevents the
operation of external physical causes. The picture is perfectly correct,
but the conclusion unauthorised.

It was indeed impossible for us not to feel the frequent necessity of
deploring those we loved. We therefore thought that we perceived this
principle operating when the evident influence of external causes, or
some mysterious agency seemed to drive the noblest results of life,
intellect and genius, from the philosopher and statesman, who had, by
the diffusion of truth and resistance to arbitrary power, preserved
the liberties, and aggrandized the happiness of nations; we thought we
perceived their influence when imagination’s powers fled from the poet
whose song had once almost conferred new life on the heroes of ancient
times; we thought we perceived their influence when the phenomena of
vital action disappeared in the body of the patriot hero in whom they
had once developed the noblest specimen of that generous love of social
life which induced him to devote his existence to his country’s weal; we
thought we perceived their influence when those magic charms abandoned
the lovely female whose powers had once excited from the philosopher
those splendid epithets that ranked her with the other objects of his
adoration, celestial truth and god-like genius—which had obtained even
from the poet those wonderful strains that at once immortalized him and
the object of his song—which had commanded, even in the hero, those
glorious devotions which, for far too short a period, illustrated the
ever memorable days of chivalry. When those eyes whose soft languor had
fascinated every beholder, those cheeks where life had often spread the
crimson veil of love—when these were gone, those eyes were dim and sunk,
those cheeks were pale, those lips were livid, that bosom depressed,
that form rigid and icy cold, when all had thus assumed the darkest
and most frightful hues, had gradually lost cohesion and become one
mass of horrible putrescence, whose infectious effluvia now threatened
destruction almost welcome to those who once adored the animated being—it
was scarcely possible to feel all this, and avoid the conclusion that
life was a state of force.

It was doubtless this unknown and imaginary power connecting the various
phenomena of organic structure that gave origin to the idea of life. But
that they are no state of force is proved by this, that while the only
notion we have of them is motion—successive attraction and repulsion,
electricity, fire &c. exhibit precisely corresponding phenomena, and the
last of these was, I believe, on that single account, considered as the
symbol of life and intellect by the great Zoroaster.

This and similar facts, I may remark, convince me, that the earth has
myriads of times been illumed by the highest attainments of intellect,
and as often plunged into darkness. This single point of Indian
philosophy was, in my opinion, but the mere shadow of the highest
excellence in philosophy in general; and as the greatest cultivation of
the human mind, and the greatest misapplication of its faculties, cannot
well exist together, I am equally convinced, that the beautiful specimens
of art, blended with heterogeneous absurdities, in the monuments of
Upper Egypt, afford the most striking proof that, contrary to the common
assertion, there _were_ periods in that country when tyrants held no
despotic sway over the physical, nor the priests of a false religion over
the moral structure of man.

But to return to the subject.—True it is that the affinities of external
agents with the molecules of organic bodies are precisely the same during
life when their influence is resisted as after death when it operates
with the greatest energy; but the power which during life organic bodies
possess of resisting the influence of external agents, and even the
extension of the sphere of their action beyond the mere bounds of the
living body, is, in my opinion, very easily accounted for.

All the particles of matter possess attraction and repulsion, and the
largest homogeneous masses, _coeteris paribus_, evidence them most.
Hence, organic bodies, while they possess homogeneity by the subsistence
of intimate relations between their parts, evidence attraction and
repulsion in the highest degree. While in infancy, these relations are
merely forming, the powers of attraction and repulsion are weak; when,
in the vigour of life, these relations are most intimate, these powers
are greatest; when, in old age, these relations are interrupted, these
powers are also diminished; and when, in death, these relations cease
to exist between the molecules, or in other words, when the body is no
longer organized, the power of combined resistance terminates.

Thus, life is no forced state, but an intrinsic power arising merely from
the intimate relation of these molecules, and the greater effects which,
in such combinations, they are capable of producing, than when, in death,
they have become independent of each other, and their powers disunited,
are capable of much less effectual resistance.

Thus, it is, that I would endeavour to shew a connexion between the
phenomena of living bodies, and the general laws of nature.

This general and common motion of all the parts, says even Cuvier, forms
so peculiarly the essence of life, that the parts which are separated
from a living body soon die, because they possess no motion of their own,
and only participate in the general motion produced by their union. Thus,
according to the beautiful expression of Kant, the mode of existence of
each part of inanimate bodies belongs to itself; but, in living bodies,
it resides in the whole.

When, I say, that life consists in motion, I make no assertion derogatory
to the Deity, for every philosopher is of opinion that motion is to us
as mysterious as life; and when I endeavour to trace in its phenomena
a correspondence with physical laws, I conceive that I pay the truest
homage to a Deity. At all events, it would be dishonest of me to give my
sanction to opinions respecting a difference which seems to me not to
subsist.

The same causes which terminate motion terminate life. Life begins
by motion, and terminates when it ceases; but very curiously it also
terminates in consequence of it. In other words, the motion wears out
the machine in which it takes place. For, while the functions are most
dependent, life encreases; and their very independence, though, to a
certain extent, the grand aim of existence, destroys it. The very cause
of decay commencing when the different functions have acquired their
greatest vigour, arises precisely from their having acquired that vigour,
and being, at that moment, most capable of a species of warfare, if I
may so term it, with each other, as well, as in some measure, from the
greater number of accidents to which a complexity of functions is liable.

That, at this period, the functions may, in a certain sense, be said
to combat each other, will be evident to every one who, for a moment,
considers that great exercise of the loco-motive functions uniformly
interrupts the vital and intellectual, or of the vital functions injures
the loco-motive and intellectual, or of the intellectual functions
injures the loco-motive and vital.

These powers are always in an inverse relation to each other.

Grimaud seems to have had some idea of this, with regard to the first
and second classes of functions. He, says Richerand, has given the most
extensive developement to the idea of the constant opposition between
those two series of actions, over which preside, according to the opinion
of this physician, two powers, which he calls loco-motive and digestive.
It is marked in no species of animals more than in the carnivorous,
which connect with senses abounding in stratagem, and muscles capable of
extraordinary action, an assimilating power of so low a degree, that
their aliment, in order to be conveniently digested, must posses a
composition analogous to that of their organs.

Thus, the independence which the functions acquire, and the interruptions
which their operations present to each other, subjects them to the common
laws of impeded motion, and its result, a separation of parts.

When, in manhood, their unison is most complete, life is most vigorous.
When, in old age, this unison ceases, life disappears. Hence also, I
am convinced, it is, that those animals whose functions are longest
dependent on each other, and who remain longest helpless, longest enjoy
organic existence.

As motion only can result from motion, so life can only result from
life. The vital actions of all animals originate in those of their
parents, from whom they are detached precisely when their actions
become sufficiently independent of them. I am convinced it is upon this
principle, that the egg is detached from the ovary and the fœtus from
the uterus, as well as because, in these cases, the ovary and the uterus
themselves, after long quiescence, recover an independent action of their
own. The same power which enables an organic body to act by itself,
forces it to separate from another.

Life then seems, in a great measure, to consist in the successive
attraction and repulsion of particles—properties equally common to
minerals, vegetables and animals, though in different manners and
degrees. Life, however, is not here to be confounded with sensibility,
which nevertheless I shall afterwards shew is also possessed by all of
them. Life seems inseparable from generation, nutrition and decay, or,
in other words, from origin, increase, diminution—a progression which
minerals and vegetables pass through as well as animals. Minerals also
increase by additions to their external surfaces, vegetables by absorbing
from without inward, and animals by absorbing from their internal as well
as external surfaces.

       *       *       *       *       *

By the intellectual functions, I understand the actions of the
intellectual organs, or, in other words, those actions which constitute
mind. With soul—the sacred and revered province of theologians, I do
not wish in the slightest degree to interfere; not for the harsh reason
assigned by atheists, namely, that the whole empire of ignorance, the
direction of the basest passions, and the gun or bayonet of the soldier
are under their command (these are sentiments which I never shall
profess), but for a juster and a better reason, namely this, that soul
is, in truth, their proper province.

Sensation, then, seems to be entirely dependent on touch, which, in the
other senses, is only modified so that one receives one kind of it, and
another receives another; thus the tongue is touched by means of liquids,
the nose by means of odours, the ear by aeriform vibrations, and the eye
by light.

All the other intellectual functions are nevertheless mere modifications
of sensation. Upon them, therefore, we shall not dwell, but, by taking
into view some important facts in anatomy, which have a relation to all
of them, I shall be able to explain sensation in particular.

Sommering has observed, that man has the largest brain in proportion to
the nerves given off from it; and that this proportional magnitude, may,
in every instance, be referred to as the best criterion of the degrees of
intelligence. Now, it appears to me not at all difficult to account for
this fact (the general truth of which may be granted), by comparing it
with another not less important, viz. that, in the inferior classes of
animals, the nervous system becomes, as you descend, more and more widely
diffused.

Hence, I deduce this important principle, viz. that the degrees of
intellect are, in all animals, in exact proportion to the concentration
of the nervous system.

Now, the more equally distributed this system is, the more independent
of each other are the parts of organized beings, or, in other words, the
necessity of a connection of these parts increases, in proportion to
the magnitude of the common trunk compared with the rami. It is only,
therefore, in the more perfect animals, that the connection of the
different parts of the nervous system, and particularly the presence of
central parts, is necessary to the existence of the different functions.

Animals, on the contrary, having this sensitive substance very generally
diffused, when mutilated, recover their figure, or, when cut into pieces,
form several individuals, having each a system of sensation and volition.
The larger warm-blooded animals acquire pieces of flesh analogous to
those which have been cut away; crabs acquire new claws; the tadpoles of
frogs and water newts acquire new limbs and tails; and the lower end of
the snail, having been divided from the upper, acquires a new head. The
earth and boatworm, when divided into considerable pieces, form several
new individuals; but animals having this system still more generally
diffused, as the polypus, when divided into the smallest fragments, each
fragment self-exists and becomes a perfect individual.

This also is more or less the case with plants. As you descend among
them, their parts become less dependent on each other. The dicotyledons,
which possess irritability, sleep and the principle of life most
diffused, and which, among plants, are analogous to the dicordated
animals, namely quadrupeds and birds, possess concentric fibres and
the most diffused sensibility; the monocotyledons, analogous to the
monocordated animals, namely reptiles and fishes, possess more numerous
centers and less diffused sensibility; and the acotyledons, analogous to
the acordated animals, possess most numerous centers and least diffused
sensibility.

As, in some worms and zoophytes, there is indeed no appearance of nerves,
and certainly none in plants, which yet possess sensibility, all this
gradually approaches to the attraction and repulsion of the magnet and
electrics, which, like some of these, are divisible almost to infinity,
and yet possess their various powers, which, like the sensibility of the
superior animals, connected by nerves, are only evidenced when led by
conductors.

Hence, I conclude, that sensation, understood in this limited sense,
as distinct from perception, and differing, _toto coelo_, from soul,
is, like extension, an imprescriptible property of all matter: but it
may exist in as many forms and as many relations as it; in its separate
particles; in larger combinations, as polypes; in still larger ones, as
worms and insects, where these extended and sentient particles, connected
by nerves, have more extensive relations and more complete dependence on
each other; or uniting to constitute perception in whole bodies, as in
the more perfect animals, where a sensorium commune exists, and where, in
consequence of the most exquisite arrangement, and the finest relations,
no particle can be deranged without affecting all the rest.

It is indeed, these various degrees in which it appears, that afford
a strictly analogical proof of its existence as a primary property of
matter.

As man then has not only sensation in the separate parts, but perception
arising from the whole, the descent is gradual to beings which have
merely sensation in distinct parts, but no general perception; and
thence equally gradual to beings which have sensation limited to their
individual particles.

Now, as the perceptions of two of the superior animals cannot unite to
form one perception, so the sensations of two parts of a polyp cannot
combine in perception; nor is it of course more wonderful, that the
sensations of two of the minute particles of matter cannot unite in one
common sensation.

As we do not expect electricity to be evidenced without conductors, why
should we expect sensation, in any great degree, without those nerves
which are its conductors? It would be as irrational to deny the former,
when conductors are not present, as to deny the latter (understood as I
have defined it), when nerves are absent.

Neither is it more wonderful that these sensations, thus limited, are not
evidenced; because it is scarcely to be expected, that the functions of
that should be evident, the absolute structure of which is unknown, and
because it is exactly in proportion to the concentration of sensation
(and by no means to its division) that it is, at any time, evidenced.

Upon the same principle, it is, that the particles of a pigment, when in
contact, are more evident than when extended over an immense surface,
or that a combination of pullies and one cord produce more evident
motion than each of them, with separate cords, could separately. But it
is unnecessary to accumulate illustrations—the principle pervades all
nature, and every natural operation illustrates it.

Nor do we merely find evident sensibility thus produced by the various
arrangements of matter: it is implicitly dependent on all the changes of
bodies, and is identified with their motions, by being suspended whenever
these are suspended. Of this, the hybernation of animals, the winter
state of most plants, the state of the embryo in utero or in ovo, of the
chrysalids of insects, the nymphs of worms, and the seeds of plants,
afford examples.

Nor is this all: but evident sensibility may be produced and destroyed at
pleasure by a mere alteration in the arrangement of the particles of one
and the same body; as in the wheel animal, and the anguillæ of tiles.

Nor is even this all: you may, if you choose, by the mere arrangement
of the particles of matter, as I shall afterwards prove by experiment,
at once produce myriads of animals, and bestow upon them motion, or in
other words, the phenomena of sensibility. This, the experiments of
Spallanzani, contrary to his own inclination, decidedly prove.

If it be objected, that it may be as fairly argued, that sensation is
something combined with these forms of matter, I answer, that we are not
entitled to suppose any thing an independent being which never appears
but in combination.

Now, as we have shown that sensation is implicitly dependent upon, or
connected with motion; and as this and all the other functions of the
brain, are entirely the results and modifications of sensation, they also
must be dependent on or connected with motion.

Far be it from me to pretend to account for mental operation by mere
physical motion. But, that motion accompanies all these processes, I am
certain; nor can the supposition that motion is made use of in the most
mysterious operations of the mind, possibly detract from the honour of a
Deity, or from our admiration of natural operations.

We have little need to be afraid of a moderate and rational materialism.
It is the idealism of Berkeley, it is the scepticism of Hume—those
dangerous opponents of such materialism, that have so deeply injured
philosophy and religion. It is according to these systems, that prophets,
apostles and miracles, are only ideas in the mind; and, indeed, the
unreasonable dislike to a rational materialism, is alone chargeable with
having led to the dangerous scepticism of Hume.

That physiologists, then, should so long have permitted others to
encroach upon their proper province, is disgraceful to them, and has
been most mischievous to science. To this is owing the barbarism of the
doctrine of mind. As physiologists abandoned it, philosophers found it
difficult to give it a name.—Some called it morals—others metaphysics—and
others, the philosophy of the mind. But I have just endeavoured to shew,
that it is neither morals nor metaphysics, nor the philosophy of the
mind—but the philosophy of the intellectual organs of the human body.




FIRST PRELIMINARY LECTURE TO THE COURSE OF PATHOLOGY AND THE PRACTICE
OF MEDICINE; EXHIBITING THE OUTLINE OF A NATURAL SYSTEM OF PATHOLOGY,
MEDICINE AND THE MATERIA MEDICA.


GENTLEMEN,

I shall not, on the present occasion, detain you with prefatory remarks;
but, as a fairer proof than any I can adduce, of the necessity of such
a course of lectures as I now propose, shall merely repeat to you, upon
this subject, the sentiments of one whom genius in the science and skill
in the art of medicine have elevated high in his profession, and whose
eloquence is not less admirable than his professional abilities.

“To ally anatomy,” says he, “more closely with surgery, to connect the
art more intimately with the science from which it flows, seems to me
a task as yet imperfectly accomplished, though of the very highest
importance.—Anatomy is not made interesting to the pupil as the basis
of our reasoning on disease, the rule of our prognostications, the sole
guide in operating: He is taught to know the parts and remember their
names, and then he is dismissed from the school; and of this school we
are all pupils, abandoned early in our career, left to learn, in the
hurry of practice, the very principles of the science!—The anatomy of
surgery differs widely from that taught in the schools.—Pathology, which
ought to unite science with art, is a sort of neutral ground betwixt the
two provinces of anatomy and surgery, little regarded on either hand.”

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

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

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

       *       *       *       *       *

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

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

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

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

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

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

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

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

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

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

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

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

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

       *       *       *       *       *

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

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

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

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

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

       *       *       *       *       *

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

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

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

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

As, however, no general theory of physiology exists, it becomes necessary
to inquire what systematic arrangement can be given to its facts, as
strictly founded on those of anatomy, in order to obtain one. And I know
none so unexceptionable as that arrangement which I have already publicly
delivered, nor any general theory so rational as the one which results
from it.

I shall now, therefore, restate these arrangements, and then try their
applicability to the medical art.

       *       *       *       *       *

Anatomy I divide into three parts, namely, that which considers the
mechanical or loco-motive organs, that which considers the vital organs,
and that which considers the intellectual organs.

Under the mechanical or loco-motive organs, I class, first, the bones
which support the rest of the animal structure; second, the ligaments
which unite them; and, third, the muscles which move them.

Under the vital organs, I class, first, the organs of digestion, the
absorbent surfaces, and the vessels which absorb from these surfaces;
second, the heart, lungs and blood-vessels which derive their contents
(the blood) from the absorbed lymph; and, third, the organs of secretion
which separate various matters from the blood.

Under the intellectual organs, I class, first, the organs of sense, where
impressions take place; second, the brain or organ of judgment, where
these excite ideas; and, third, the nerves, where volition results from
the last.

This is a natural arrangement of the anatomy of animals, and its peculiar
simplicity is illustrated by its involving, in application, that of
minerals and vegetables, and by its being capable of instant adaption to
physiological science.

In order to arrange animal physiology, it is only necessary to substitute
the term “functions” for “organs;” and that science will likewise
involve, in application, the physiology of mineral and vegetable bodies,
and be, in its turn, capable of instant adaption to medical science.

Thus, the functions also are divided into mechanical, vital and
intellectual.

The mechanical functions are subdivided into that of support, that of
connection and that of loco-motion.

The vital functions are divided into that of absorption, that of
circulation and that of secretion.

The intellectual functions are divided into that of sensation, that of
mental operation and that of volition.

In order to arrange medical science, for the term “healthy functions,”
the subject of physiology, it is only necessary to substitute the term,
“diseased functions.”

The classes of disease are, therefore, like those of anatomy and
physiology, three, namely, diseases of the mechanical or loco-motive
functions, diseases of the vital functions, and diseases of the
intellectual functions.

The orders of the first class, as affecting the functions of the bones,
the ligaments and the muscles, are three, viz. diseases of support,
diseases of connection, and diseases of loco-motion.

Those of the second class, as affecting the functions of the absorbent,
circulating and secreting vessels, are likewise three, viz. diseases of
absorption, diseases of circulation and diseases of secretion.

Those of the third class, as affecting the functions of the organs of
sense, of the brain and of the nerves, are also three, viz. diseases of
impression, diseases of judgment and diseases of volition.

The genera, under each order, consist of diminished, irregular and
increased function.

This arrangement of disease likewise involves in application, that of
minerals (if we choose to maintain the analogy and to give that term
to mere injury of structure) and of vegetables, as well as animals.
The first have what may be termed diseases of mechanical structure;
the second have diseases of mechanical and vital functions; whilst the
third have diseases of mechanical, vital and intellectual functions;
corresponding with the observation that animals exist, vegetables exist
and live, and animals exist, live and think.

Precisely in the same way, would I class the articles of the materia
medica; first, as operating upon the mechanical, vital or intellectual
organs, and then as either increasing, rendering irregular, or
diminishing their action.

In this natural arrangement, I must again remark, that all its parts
correctly correspond and beautifully flow from each other; while anatomy
is the basis of physiology, physiology, in its turn, is the basis of
medicine; the classification of one is applicable to the rest, and all of
them at once involve mineral, vegetable and animal nature.

Such arrangement, as it lays the foundation of a new system of each,
will, I trust, soon shed some light over anatomical, over physiological,
and particularly over the dark paths of medical science; but it must be
remembered, that this exhibits merely a sketch of the application of my
general arrangement to medical science, and that sketch necessarily brief
and deprived of every illustration. Yet, even after this sketch, I think
I may add, in the words of Lord Bacon, that “the harmony of a science,
supporting each part the other, is and ought to be the true and brief
confutation and suppression of all the smaller sorts of objections.”

I shall now, however, further explain the principles upon which the
natural system is constructed.

       *       *       *       *       *

The correctness of this arrangement, as strictly founded on physiology,
is confirmed by the following observations.

Disease is change of the healthy state and of the healthy action of
parts. It is change of the state as well as of the action of parts,
because action depends on state, life itself on organization, and it is
only by affecting this state—the structure of the objects acting, that
change of action can be produced. In fracture, as far as the bone is
concerned, the action peculiar to it—loco-motion is affected; as the
blood-vessels are ruptured, their action is affected; as the nerves are
injured, their peculiar action is also affected.

Thus each has its peculiar action, and the action of each is affected
through the medium of its structure; but the affection of the state and
action of the vessels or nerves is not, in fracture, the primary disease,
but only an extension of it to other parts or other functions, or, more
properly, they are new diseases, because they affect new functions, and,
though dependent upon it, are, in their nature, entirely different from
fracture—the primary disease.

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

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

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

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

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

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

As individual diseases are not arranged under the table, I may, in order
to render my meaning perfectly obvious, give one or two examples of
this mode of classification. Thus with regard to the classes or first
and most general divisions of disease, _fracture_ is a disease of the
mechanical functions, _syphilis_ of the vital functions, and _mania_ of
the intellectual functions. With regard to the orders or second and less
general divisions of disease in the last of these classes, _amaurosis_
is a disease of impression or sensation, _mania_ of mental operation,
and _paralysis_ of expression or volition. And with regard to the genera
or subdivisions of disease in the second of these orders, _fatuitas_ is
a disease of diminished mental operation, _mania_ of depraved mental
operation, and _vigilia_ of increased mental operation. Farther, with
regard to the combination of disease under the last class, (sleep
itself consisting in the quiescence of almost all the intellectual
functions), _dreaming_ consists chiefly in the quiescence of sensation,
_somnambulism_ chiefly in that of mental operation and _incubus_ chiefly
in that of volition.

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

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

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

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

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

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

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

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

       *       *       *       *       *

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

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

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

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




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


GENTLEMEN,

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

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

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

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

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

       *       *       *       *       *

To obviate this train of miseries; to give ease and satisfaction to the
operator, by conferring precision and success upon his operation, and
to rescue from death, or rather from torture and agony, innumerable
sufferers, are the results which I confidently expect from the adoption
of the following method. Nor can I say more in proof of its importance.
I doubt not, that it will, ultimately, constitute the basis and direct
the genius of surgery.

       *       *       *       *       *

There exists no other method of effecting this, than by the enunciation
of the following principle; namely, that there is, especially in such
parts as are not liable to be deranged by voluntary motion, an invariable
relation between the arrangements of internal and the situation of
external parts, which may justly be considered as accurate signs of them;
in consequence of which, by adopting, on each side of the nerve, artery
or other subject of operation, a fixed point, or one rendered fixed by
particular positions of the body; and by dividing, according to a line
or rule, the space between these fixed points into a given number of
proportional parts, _i. s._ parts, not equally large in all subjects,
but uniformly of the same size, with relation to the whole which they
compose, and generally differing in the male and female—by these means, I
say, the situation of any given subject of operation, in any given part
of the body, may be most accurately indicated, as being undeviatingly a
certain number of proportional parts distant from the one, and a certain
number from the other of these points.

Thus does anatomy, by what I term precise or real proportional
measurements between fixed points, afford an obvious and simple, though
hitherto unobserved, general means of rendering the operations of surgery
perfectly precise and easy.

Indeed, such wonderful precision and ease do these real proportional
measurements confer, that, by means of them, the finest instrument may be
passed from the surface of the body through any great nerve or vessel
that is liable to be the subject of surgical operation.

Having stated this principle, I may merely observe, that, proceeding
with all the ease and security, such accuracy must infallibly confer,
it is, in all operations the first duty of the operator to ascertain
by feeling, as nearly as possible, the thickness of cellular substance
situate immediately under the skin of the patient, and then, with a bold
and steady hand, to make an incision, deep in proportion to the thickness
of that substance, and long in proportion to its depth, as well as to the
additional depth and extent of the part to be operated upon.

These general principles excepted, other subordinate rules are chiefly
applicable to particular operations.

       *       *       *       *       *

In order to illustrate this general principle, I cannot adduce a fairer
or a better example than that which, according to it, is necessary to
direct the taking up of the subclavian artery above the clavicle.

The patient must, in this operation, rest on the fundament, his body
slightly inclining backward, so as to form an obtuse angle with the
thighs, and his neck and head inclined backward so as to form with the
trunk an angle similar to that formed by it with the thighs; the inferior
of these angles being concave, the superior convex. This last may indeed
be more properly called an irregular segment of a circle, formed in
consequence of the vertebrae of the neck bending in that direction. In
this position, therefore, the neck is, in general, in the same parallel
with the thighs. The head of the patient is to be turned to the opposite
side from that in which the operation is to be performed, where also the
operator must stand. The light must fall directly downward from the head
of the patient.

In this case then, the bringing of the shoulder forward and downward,
which I deem indispensible, however necessary to the ease of the
operator, is not very material to the correctness of the measurement.
It is however of some consequence; for, as the subsequent measurement
is dependent on the clavicle, and as that bone describes a portion of
a circle in having its lateral end brought forward, every single point
of it would, in that position, have a different relation to the vessels
beneath from that which each would have had, if kept in its usual
position.

Here then, the shoulder being in this position, and the arm held by the
side, the measurement commences, and the fixed point chosen on each side
of the immediate subject operation are the two ends of the clavicle; as
nearly between these as can be done, consistently with keeping quite
clear of the bone, a line must be drawn superior and internal to it,
and the given number of proportional parts, into which this line must
be divided, are seven in number both in the male and female; and now
the situation of the artery may be most accurately indicated as being
undeviatingly three of these proportional parts distant from the inner,
and four from the outer end of the clavicle; in consequence of which, if
a fine instrument, held at right angles to the clavicle, were directed
downward and inward, it would at 1 and ¼ of the above mentioned parts
from the surface of the clavicle, reach the artery, and being pushed
farther, would pass through it.

This is an absolute demonstration of the precision and ease attending the
principle I have announced, and of its applicability even to the most
difficult of all operations.

In order, however, to perform the operation throughout, the point which I
have indicated must be the center of an incision through the integuments
made in the line above mentioned, and must extend at least two parts
inward and two outward from the central point. Over the Trapezius
outward, and over the clavicular attachment of the Sterno-cleido-mastoid
muscle inward, it is not adviseable to cut deeper than the integuments,
which sufficiently relieves the hand of the operator, without the present
execrable practice of dividing the last mentioned muscle, which is not
only unnecessary, but highly faulty, as this attachment serves as one
of those particular points, above alluded to, incidental to certain
operations, which, by means of its edge, kept lax during the operation,
very nearly directs the knife to a small protuberance on the superior
anterior surface of the first rib to which the scalenus primus is
attached, and immediately external to which the artery itself lies.

Above all, the incision ought to be cautiously continued on the inner
side, in order to avoid the large veins situate there; various branches
of these veins may come in the way, and the more considerable may be
easily avoided, but if not, they may be tyed.

In continuing the incision inward and downward, an ascending branch
of the vein is in the way, which, when it is considerable, may also,
previous to the continuance of the incision, be tyed. The incision
itself, as you pass inward, must be very limited indeed, as the jugular
vein is internal to it; and external to it there is a twig of the
brachial nerve, both of which are much exposed to injury.

When the incision has been made one and a fourth of these proportional
parts inward from the outside of the clavicle, you have reached the
artery. It lays external to that protuberance of the first rib into
which, as already observed, the scalenus primus is inserted, and
consequently to the insertion of the muscle itself. The twig of the
nerve actually crosses the artery immediately below the point where the
latter ought to be tyed. The course of the artery is, in descending,
obliquely outward, and the precise space in which it lays resembles
an isosceles triangle formed by the clavicle, clavicular portion of
the sterno-cleido-mastoideus and the omo hyodeus; its base being the
clavicular portion of the sterno-cleido-mastoideus. The nerve is external
and anterior to the artery, particularly its branch. Both the twig and
trunk of the nerve ought to be seen by the operator before he attempt to
take up the artery.

These directions are so precise, that, were the operator blind and the
artery destitute of pulsation, he need not scruple to take up that which
presents itself in the above mentioned situation.

By similar measurements, may every great artery in the body, liable to
be the subject of surgical operation, be discovered with similar ease
and precision, nor does there exist any other method of effecting this
purpose.

I shall now then state the objections which may be urged against this
principle.

       *       *       *       *       *

It may be objected to the adoption of this fundamental principle of all
surgical operation.

_1st_, That the accidental and probable fracture of the bone affording
the fixed points, would, by deranging these points, render all such
measurement inapplicable.

_2d_, That varieties in the distribution of arteries, and those
deviations which are often produced by disease, would have the same
effect.

I know not of any other objection that can be urged against it, and these
I shall immediately answer.

       *       *       *       *       *

_1st_, To the objection that the accidental and probable fracture of
the bone affording the fixed points would, by deranging these points,
render all such measurements inapplicable, I answer, that, to chuse as
an example the operation I formerly described, it is, in such a case,
only necessary to transfer the measurement to the sound clavicle,
and to convert the three inner or four outer proportional parts into
absolute inches, quantities similar to which may then be measured from
the corresponding ends of the fractured one, and thereby indicate the
situation of the vessel or nerve with as great precision as if no
fracture were involved.

_2d_, To the objection that varieties in the distribution of arteries,
and those deviations which are often produced by disease, would have the
same effect, I answer, that variety of distribution does not at all take
place in some of those parts in which the most important operations have
to be performed; namely, high in the groin, above and below the clavicle,
&c. and that, wherever great deviation is caused by disease, it will
generally be attended by external signs, according to which the operator
may modify his measurements. I also further answer, that wherever
deviation, from either of these causes, occurs, he who, by means of these
measurements, knows the precise situation, according to the most usual
and regular structure, will have the most decided advantage over him
who is ignorant of it: the former will possess data, from which he can
calculate probable deviations, the latter none; the former, even at the
worst, will have to _calculate_, the latter will be unable to do more
than _guess_.

Thus I have answered the only objections that it is possible to urge
against the principle proposed.

I have already said, that private objections by persons who dare not
publicly make one, and who themselves cannot, by one or two incisions,
approach within several inches of any artery, I shall uniformly despise,
and shall only ask them to perform the operation with my youngest pupil.

I shall now deliver a short history of the method proposed.

       *       *       *       *       *

The want of some guide to the situation of internal parts, has long
been felt. Fixed points have been adopted, but with no regularity.
Measurements guessed by the eye have sometimes been used, but even
they have almost always been absolute, _i. s._ measurements from one
point; rarely proportional, _i. s._ measurements between two points.
The few guessed proportional measurements, however, as for paracentesis
abdominis, paracentesis thoracis, &c. which have been mentioned in
surgical works, have, it must be confessed, been such as, from the
magnitude of the parts with which they were concerned, required little
more than guess. Such, however, as they were, they evidently depended
upon no principle, but seem as if hit upon accidentally, and, at all
events, were never generally applied.

Precise or real proportional measurements between fixed points,
applicable to minute objects, _i. s._ such measurements as I have
proposed and described, never have been, as far as I can discover,
proposed and described before. And these precise or real proportional
measurements, between fixed points, differ exactly as much from guessed
ones, as the accurate cabinet, which was regulated in every part by the
compass and square, would differ from the clumsy and unserviceable one,
where every thing was constructed by guess. Here the parallel is so
close, the difference in the results so striking, that I could not have
adduced a better illustration.

The present proposition, of precise or real proportional measurements
between fixed points, was communicated by me, about five or six years
ago, to James Macartney Esq. lecturer on comparative anatomy, and the
laws of organic existence, at St. Bartholomew’s Hospital, and, in my
opinion, one of the best comparative anatomists in Europe. I had no
sooner announced it, than he assured me that a similar method had struck
himself; and I deem this, so far as authority goes, no mean testimony in
behalf of its value.

Mr Macartney, some time afterward, performed upon the dead subject,
in the dissecting room at St. Bartholomew’s, the difficult operation
I have just described, according to the direction I have given, and
both politely acknowledged me as the proposer, and bestowed on it his
approbation. It is my duty to remark, that there is no person whose
approbation could give me higher satisfaction.

       *       *       *       *       *

I cannot better illustrate the danger arising from ignorance of this
principle, than by quoting an instance of repeated failure in the very
operation above described, in consequence of such ignorance.

A professor at an hospital in London, generally reckoned one of the
ablest surgeons of the metropolis, when illustrating this operation in
his lectures, first made the usual guessed cut, passing across one half
of the Sterno-cleido-mastoid muscle; and, after some tearing and cutting,
and innumerable complaints against the knives and the unfortunate
assistant, told his pupils, “that they might think he had not yet got the
artery, but he knew he had, and he should know it in the living subject,
even if it did not pulsate.” The subject, however, was carried from the
lecture-room, and the ligature was found to be firmly fixed upon the
nerve.

This mistake was very properly communicated to the ingenious surgeon,
who never forgave the discoverer of it, but very wisely planned how he
might avoid the same mistake, or, what he seemed to dread most, its
consequences to his own reputation, in the subsequent course.

He had thus found, that ligatures left in the dead subject were more
troublesome than in the living; and having tied something, which, to
judge from the vague way in which he described it, might be a muscle as
readily as an artery, he very properly, as his mind was not quite made up
upon the subject, secured, to all appearance, his well earned fame, by
cutting off and withdrawing the ligature that nobody might see what he
had done.

Unfortunately, however, curiosity and the wonder that it was possible for
so great a surgeon to make so deplorable and dangerous an error, prompted
a second examination of the subject. No ligature now remained to direct
the enquirer’s search; but alas! artifice could not obtain impunity even
to reputation—the artery remained bedded in fat and untouched, the nerve
alone was separated from the mass, and bore the mark of the ligature.

May the relation of these disgraceful occurrences, selected from numerous
similar ones, which, to my knowledge, have taken place both in London
and Edinburgh; but which, as, fortunately for their authors, they produce
no injury to reputation, I am therefore unwilling to state—may it, I say,
serve as a proof of the danger arising from ignorance of the principle I
have proposed.

Now, may I ask, what are we to think of the supporters—the promulgators
of such doctrines, and the abettors of their authors? Such men are to be
found in Edinburgh, as well as in London.

Suppose, for a moment, one of these gentlemen, who are the deriders of
precise and accurate methods, proposing to perform on the dead subject,
in the most fascinating and splendid style, the operation for tying the
femoral artery. He delivers a proem which shall verbally assure the pupil
of its ease, but, by the complex flourishes of his knife, he intends to
convince him it is difficult. He expects, however, that he shall speedily
lay it bare, and that his dexterity, in the midst of such complexity,
will produce the most brilliant effect. But alas! his first incision
is made about an inch from the artery—still he cuts deep, in order to
discover it—now he is embarrassed at his situation—next he mines off
laterally, forms excavations under the flesh, and leaves the artery above
the course of his incision—at last he reaches the profound, instead of
the superficial artery, and comes off with the never-failing, and, in
this case, ridiculous excuse, that there was an unusual distribution of
it.... The errors of Surgeons have very curiously discovered a greater
number of varieties in the distribution of arteries than ever were
demonstrated by the labours of anatomists.

I have seen one of these surgeons commence such a disgraceful operation
with more flourishes of the knife, than ever a dragoon used when
performing the Saxon exercise with the sabre. Contrast this with the
plain and manly operator, every movement of whose knife has a meaning,
because every movement of it is strictly adapted to effect the most
useful of purposes.[1]

    [1] It may be surprising, but it is not inconsistent with human
    nature, that such men should be the persecutors of others; and
    it may perhaps be worth while to quote a few sentences from the
    production of such men directed against myself.

    “While an intimate acquaintance with the Anatomy of the human
    body, is absolutely necessary to him who wishes to practise
    Surgery, with credit and success, it must be acknowledged, that
    _those who are much occupied with dissection, are but too apt
    to overrate the practical importance of a minute knowledge of
    healthy structure_. That surgeon would indeed justly hazard the
    imputation of rashness and presumption, who would (_should_
    is here meant) imprudently venture to apply a ligature to
    the carotid or subclavian arteries, or attempt to remove the
    stricture in a strangulated crural hernia, without an accurate
    knowledge of the assemblage of important vessels which are
    included in the regions of the neck and groin: yet _we do
    not allow ourselves to be much influenced by the opinions of
    the anatomist who affirms, that there are certain fixed and
    invariable rules, according to which, in every case, those
    operations are to be performed_. We have learnt to infer, that
    the different regions of the body include almost constantly
    similar organs in every individual; and we know, that these
    organs have usually a general relation to each other, in form,
    magnitude, and position. Yet very little further observation is
    sufficient to convince us, that these relations do not admit
    of being determined with mathematical precision. The form
    and position of parts, ascertained with the most scrupulous
    accuracy in one individual, are not to be adopted as the
    basis of a system of rules, by which the operative surgeon
    is invariably to be directed in the practice of his art. To
    inculcate on the minds of the inexperienced, that surgical
    operation consists merely in the study of the external form,
    and that it is solely regulated by the mathematical bearings of
    certain prominences and depressions on the surface of the body,
    is to encourage the rash and the ignorant to sport with the
    lives of their fellow creatures, and entail disgrace and misery
    on themselves.”

    What must the liberal and candid think of this, when they are
    informed that the misrepresentations which I now quote, are the
    production of a party, of whom more than one intends to give
    a course of lectures on subjects similar to the man against
    whom they privately direct these attacks!... What they want
    in intellect and genius, they compensate for in numbers and
    in stratagem. I am aware that these gentlemen may influence
    some of better minds than their own; but I shall entrust their
    confutation and their shame to demonstration and the evidence
    of facts.

    When _I_ have mistaken the femoral artery for the profunda;
    when _I_ have taken up arteries in amputation before sawing
    off the bone; and when, in attempting to perform the operation
    of Lithotomy, _I_ have been forced to abandon it, publicly
    to attempt an explanation in apology for the blunder, and
    then obliged to leave it, to see whether THE STONE WOULD COME
    AWAY OF ITSELF! or be, as is perpetually the case on similar
    occasions, privately extracted by another—when I have done
    all this, and made myself an object of laughter even to the
    youngest pupil—then, then I shall cease even to speak of
    Surgery or Medicine.

I have now only to add a few words concerning the necessity of such
precise methods of operation in the present military state of Europe.

       *       *       *       *       *

While such important operations remain in so vague a state, what ease
would not such measurements confer, when, in the cockpit of the man of
war or on the field of battle, the perplexed and bewildered surgeon knows
not where to turn him, but must leave an hundred operations in an hour to
an unexperienced assistant.

At a time, when a successful conspiracy of adventurous ruffians are, at
the point of the bayonet, establishing, from the Don to the Douro, from
the Scheldt to the Cattarro, over all the fairest provinces of Europe,
the most dreadful of military despotisms;—at a time, when, to the shout
“Avance, Avance,” louder and more tremendous than the noise of their
guns, the myriad legions of France are carrying death and destruction
before them, and sweeping together man and civilization from the face of
the Continent;—at a time, when he who has “sceptres tipt with coronets
for his pallisadoes, kingdoms for his martello towers and kings for his
centinels,” threats at once the liberties and the existence of Britain,
and stains every step of his career with perfidy and blood;—at a time,
when it is the duty—it is the wish of every man of honour successfully
to defend, or, covered with wounds, nobly to die for the liberties of
Britain and the emancipation of Europe—when all this is the case, what
are not his duties whose sole profession it is, aided by science, to
rescue from death or agony those whom tyranny has attempted to destroy,
the genius of whose god-like art it is to save both friends and foes;
and, upon whose knowledge, the existence and the fate of armies may, in
no small degree, be said to depend.

Never were the duties of the military surgeon more complex or more
formidable. Never did he stand in need of greater precision. And, in his
art at least, he ought to recollect that no commissions are sold—the
precisest knowledge alone entitles to—infallibly secures, pre-eminence
and fortune.




_POSTSCRIPT._


Since the publication of my Prospectus, and of the observations delivered
in the previous note, the persons to whom that note alludes, have become
ashamed of their conduct, and have, both in their lectures and through
the press, asserted that I was not the object of their public attack;
but that, _although it was quite unconnected with the object of the
pamphlet in which it appeared_, yet they had taken the trouble to direct
the attack against a gentleman at almost a thousand miles distance from
them, and only two copies of whose book had ever reached the country;
because, I suppose, they were alarmed lest, at that _short distance_,
that gentleman should influence attendance upon their lectures, and lest
a work so _widely diffused_ over the country should “encourage the rash
and the ignorant to sport, _by means of accurate measurements_, with
the lives of their fellow creatures, and entail disgrace and misery
on themselves....” _Humanity_ is certainly deeply indebted to their
generous, disinterested and philanthropic exertions! How much to be
regretted that it has not ever had such guardians! Monuments doubtless,
rivalling that of the hero of Trafalgar, will be erected to their
memory—monuments of a nobler kind, because destined to record, not the
triumphs of war, but the triumphs of lectureship in anatomy, physiology
and surgery, which certainly involve, not the destruction, but the
preservation of lives.

What! M. Richerand, only at a thousand miles distance, influencing the
_newly organized_ courses of lectures in Edinburgh, and _two copies_ of
his dangerous book, proposing precise measurements in surgery, _actually_
in the British empire.—Some gentlemen, perhaps, may be sufficiently
ill-informed to imagine that the attack was really directed against so
weak a creature as myself. How improbable! It is self-evident that I, _in
Edinburgh_, could not have a thousandth part of the influence upon their
lectures, that M. Richerand could _at the distance of a thousand miles_,
and that my lectures, inculcating the principle _every day_, could not
have a millionth part of the tendency to “encourage the rash and ignorant
to sport, _by means of accurate measurements_, with the lives of their
fellow creatures and entail disgrace and misery on themselves,” that _two
copies_ of M. Richerand’s book, actually in the country, must infallibly
have.... He would be almost mad who could suppose the allusion was to me,
because I was at hand and _therefore_ could have no influence upon their
lectures; I was delivering these opinions every day, and they _therefore_
could not be disseminated: hence these gentlemen had no earthly interest
in alluding to me. He, on the contrary, is wise who supposes that the
allusion is to M. Richerand, because he is in Paris and _therefore_ must
have great influence upon their lectures; of his book even two copies
are in the British empire and its sentiments _consequently_ must be most
widely disseminated; and it was _well contrived_ and _inexpressibly
humane_ to introduce and firmly to oppose such a _desperate_ character,
even in a work upon a _different subject_. In short, these gentlemen
had the nearest interest in opposing him.... Well, it must certainly
be highly satisfactory to have thus opposed the progress of error
and rescued the human race from _disgrace_ and _misery_. Generous,
disinterested, philanthropic defenders of _humanity_, you have your
reward _in your own breasts_.

But their apology will not bear the test of ridicule. Let us therefore
examine, in another way, the foundation upon which it rests.

After denying the truth of the principle they ascribe it to another.
And who is ignorant that this has been the fate of every original
proposition? M. Richerand, they say, discovered it in 1805. Now granting,
for a moment, the truth of this, I preceded him by a year or two at
least, and James Macartney, Esq. lecturer on comparative anatomy, even
constructed, twelve months before the time they mention, a work upon the
principle, for which he was favoured with drawings by Charles Bell, Esq.
at the time the discovery is ascribed to M. Richerand. I mention these
facts because, even granting the truth of what these gentlemen state, it
refutes the assertions they found upon it.—I shall make a point of laying
the further details on this subject (to me very important) before the
medical world, which will show that, _even since I first enunciated the
principle_, neither M. Richerand, nor any other person, has even repeated
the proposition, and I defy these gentlemen to produce an instance of it.
This, however, I must remark, even these gentlemen most inconsistently
grant; for they say that the proposal, which they assert was made by
M. Richerand, has been tried and has _failed_; whereas the proposition
enunciated by me has been tried, has _uniformly succeeded_, and, such is
its correctness, that it constitutes the basis of that part of my course
which involves the operations of surgery. Therefore, even according to
themselves, _the propositions cannot be the same_.

I may now conclude by observing, that, notwithstanding the conduct of
these gentlemen, I am far from bearing them any personal dislike,—but
shall, on the contrary, be happy to labour with them in the same
vineyard, and wish them the utmost success.

       *       *       *       *       *

Mr WALKER’S Course of ANATOMY and PHYSIOLOGY recommences on _Tuesday the
8th of November, at_ ELEVEN O’CLOCK, a. m. and his Course of PATHOLOGY
and the PRACTICE OF MEDICINE, at TWO O’CLOCK, p. m. and will be continued
daily at these hours, at No. 63, SOUTH BRIDGE-STREET.



*** END OF THE PROJECT GUTENBERG EBOOK OUTLINE OF A NATURAL SYSTEM OF MEDICAL SCIENCE ***


    

Updated editions will replace the previous one—the old editions will
be renamed.

Creating the works from print editions not protected by U.S. copyright
law means that no one owns a United States copyright in these works,
so the Foundation (and you!) can copy and distribute it in the United
States without permission and without paying copyright
royalties. Special rules, set forth in the General Terms of Use part
of this license, apply to copying and distributing Project
Gutenberg™ electronic works to protect the PROJECT GUTENBERG™
concept and trademark. Project Gutenberg is a registered trademark,
and may not be used if you charge for an eBook, except by following
the terms of the trademark license, including paying royalties for use
of the Project Gutenberg trademark. If you do not charge anything for
copies of this eBook, complying with the trademark license is very
easy. You may use this eBook for nearly any purpose such as creation
of derivative works, reports, performances and research. Project
Gutenberg eBooks may be modified and printed and given away—you may
do practically ANYTHING in the United States with eBooks not protected
by U.S. copyright law. Redistribution is subject to the trademark
license, especially commercial redistribution.


START: FULL LICENSE

THE FULL PROJECT GUTENBERG™ LICENSE

PLEASE READ THIS BEFORE YOU DISTRIBUTE OR USE THIS WORK

To protect the Project Gutenberg™ mission of promoting the free
distribution of electronic works, by using or distributing this work
(or any other work associated in any way with the phrase “Project
Gutenberg”), you agree to comply with all the terms of the Full
Project Gutenberg License available with this file or online at
www.gutenberg.org/license.

Section 1. General Terms of Use and Redistributing Project Gutenberg
electronic works

1.A. By reading or using any part of this Project Gutenberg
electronic work, you indicate that you have read, understand, agree to
and accept all the terms of this license and intellectual property
(trademark/copyright) agreement. If you do not agree to abide by all
the terms of this agreement, you must cease using and return or
destroy all copies of Project Gutenberg electronic works in your
possession. If you paid a fee for obtaining a copy of or access to a
Project Gutenberg electronic work and you do not agree to be bound
by the terms of this agreement, you may obtain a refund from the person
or entity to whom you paid the fee as set forth in paragraph 1.E.8.

1.B. “Project Gutenberg” is a registered trademark. It may only be
used on or associated in any way with an electronic work by people who
agree to be bound by the terms of this agreement. There are a few
things that you can do with most Project Gutenberg electronic works
even without complying with the full terms of this agreement. See
paragraph 1.C below. There are a lot of things you can do with Project
Gutenberg electronic works if you follow the terms of this
agreement and help preserve free future access to Project Gutenberg
electronic works. See paragraph 1.E below.

1.C. The Project Gutenberg Literary Archive Foundation (“the
Foundation” or PGLAF), owns a compilation copyright in the collection
of Project Gutenberg electronic works. Nearly all the individual
works in the collection are in the public domain in the United
States. If an individual work is unprotected by copyright law in the
United States and you are located in the United States, we do not
claim a right to prevent you from copying, distributing, performing,
displaying or creating derivative works based on the work as long as
all references to Project Gutenberg are removed. Of course, we hope
that you will support the Project Gutenberg mission of promoting
free access to electronic works by freely sharing Project Gutenberg
works in compliance with the terms of this agreement for keeping the
Project Gutenberg name associated with the work. You can easily
comply with the terms of this agreement by keeping this work in the
same format with its attached full Project Gutenberg License when
you share it without charge with others.

1.D. The copyright laws of the place where you are located also govern
what you can do with this work. Copyright laws in most countries are
in a constant state of change. If you are outside the United States,
check the laws of your country in addition to the terms of this
agreement before downloading, copying, displaying, performing,
distributing or creating derivative works based on this work or any
other Project Gutenberg work. The Foundation makes no
representations concerning the copyright status of any work in any
country other than the United States.

1.E. Unless you have removed all references to Project Gutenberg:

1.E.1. The following sentence, with active links to, or other
immediate access to, the full Project Gutenberg License must appear
prominently whenever any copy of a Project Gutenberg work (any work
on which the phrase “Project Gutenberg” appears, or with which the
phrase “Project Gutenberg” is associated) is accessed, displayed,
performed, viewed, copied or distributed:

    This eBook is for the use of anyone anywhere in the United States and most
    other parts of the world at no cost and with almost no restrictions
    whatsoever. You may copy it, give it away or re-use it under the terms
    of the Project Gutenberg™ License included with this eBook or online
    at www.gutenberg.org. If you
    are not located in the United States, you will have to check the laws
    of the country where you are located before using this eBook.
  
1.E.2. If an individual Project Gutenberg electronic work is
derived from texts not protected by U.S. copyright law (does not
contain a notice indicating that it is posted with permission of the
copyright holder), the work can be copied and distributed to anyone in
the United States without paying any fees or charges. If you are
redistributing or providing access to a work with the phrase “Project
Gutenberg” associated with or appearing on the work, you must comply
either with the requirements of paragraphs 1.E.1 through 1.E.7 or
obtain permission for the use of the work and the Project Gutenberg
trademark as set forth in paragraphs 1.E.8 or 1.E.9.

1.E.3. If an individual Project Gutenberg electronic work is posted
with the permission of the copyright holder, your use and distribution
must comply with both paragraphs 1.E.1 through 1.E.7 and any
additional terms imposed by the copyright holder. Additional terms
will be linked to the Project Gutenberg License for all works
posted with the permission of the copyright holder found at the
beginning of this work.

1.E.4. Do not unlink or detach or remove the full Project Gutenberg
License terms from this work, or any files containing a part of this
work or any other work associated with Project Gutenberg.

1.E.5. Do not copy, display, perform, distribute or redistribute this
electronic work, or any part of this electronic work, without
prominently displaying the sentence set forth in paragraph 1.E.1 with
active links or immediate access to the full terms of the Project
Gutenberg License.

1.E.6. You may convert to and distribute this work in any binary,
compressed, marked up, nonproprietary or proprietary form, including
any word processing or hypertext form. However, if you provide access
to or distribute copies of a Project Gutenberg work in a format
other than “Plain Vanilla ASCII” or other format used in the official
version posted on the official Project Gutenberg website
(www.gutenberg.org), you must, at no additional cost, fee or expense
to the user, provide a copy, a means of exporting a copy, or a means
of obtaining a copy upon request, of the work in its original “Plain
Vanilla ASCII” or other form. Any alternate format must include the
full Project Gutenberg License as specified in paragraph 1.E.1.

1.E.7. Do not charge a fee for access to, viewing, displaying,
performing, copying or distributing any Project Gutenberg works
unless you comply with paragraph 1.E.8 or 1.E.9.

1.E.8. You may charge a reasonable fee for copies of or providing
access to or distributing Project Gutenberg electronic works
provided that:

    • You pay a royalty fee of 20% of the gross profits you derive from
        the use of Project Gutenberg works calculated using the method
        you already use to calculate your applicable taxes. The fee is owed
        to the owner of the Project Gutenberg trademark, but he has
        agreed to donate royalties under this paragraph to the Project
        Gutenberg Literary Archive Foundation. Royalty payments must be paid
        within 60 days following each date on which you prepare (or are
        legally required to prepare) your periodic tax returns. Royalty
        payments should be clearly marked as such and sent to the Project
        Gutenberg Literary Archive Foundation at the address specified in
        Section 4, “Information about donations to the Project Gutenberg
        Literary Archive Foundation.”
    
    • You provide a full refund of any money paid by a user who notifies
        you in writing (or by e-mail) within 30 days of receipt that s/he
        does not agree to the terms of the full Project Gutenberg™
        License. You must require such a user to return or destroy all
        copies of the works possessed in a physical medium and discontinue
        all use of and all access to other copies of Project Gutenberg™
        works.
    
    • You provide, in accordance with paragraph 1.F.3, a full refund of
        any money paid for a work or a replacement copy, if a defect in the
        electronic work is discovered and reported to you within 90 days of
        receipt of the work.
    
    • You comply with all other terms of this agreement for free
        distribution of Project Gutenberg™ works.
    

1.E.9. If you wish to charge a fee or distribute a Project
Gutenberg™ electronic work or group of works on different terms than
are set forth in this agreement, you must obtain permission in writing
from the Project Gutenberg Literary Archive Foundation, the manager of
the Project Gutenberg™ trademark. Contact the Foundation as set
forth in Section 3 below.

1.F.

1.F.1. Project Gutenberg volunteers and employees expend considerable
effort to identify, do copyright research on, transcribe and proofread
works not protected by U.S. copyright law in creating the Project
Gutenberg™ collection. Despite these efforts, Project Gutenberg™
electronic works, and the medium on which they may be stored, may
contain “Defects,” such as, but not limited to, incomplete, inaccurate
or corrupt data, transcription errors, a copyright or other
intellectual property infringement, a defective or damaged disk or
other medium, a computer virus, or computer codes that damage or
cannot be read by your equipment.

1.F.2. LIMITED WARRANTY, DISCLAIMER OF DAMAGES - Except for the “Right
of Replacement or Refund” described in paragraph 1.F.3, the Project
Gutenberg Literary Archive Foundation, the owner of the Project
Gutenberg™ trademark, and any other party distributing a Project
Gutenberg™ electronic work under this agreement, disclaim all
liability to you for damages, costs and expenses, including legal
fees. YOU AGREE THAT YOU HAVE NO REMEDIES FOR NEGLIGENCE, STRICT
LIABILITY, BREACH OF WARRANTY OR BREACH OF CONTRACT EXCEPT THOSE
PROVIDED IN PARAGRAPH 1.F.3. YOU AGREE THAT THE FOUNDATION, THE
TRADEMARK OWNER, AND ANY DISTRIBUTOR UNDER THIS AGREEMENT WILL NOT BE
LIABLE TO YOU FOR ACTUAL, DIRECT, INDIRECT, CONSEQUENTIAL, PUNITIVE OR
INCIDENTAL DAMAGES EVEN IF YOU GIVE NOTICE OF THE POSSIBILITY OF SUCH
DAMAGE.

1.F.3. LIMITED RIGHT OF REPLACEMENT OR REFUND - If you discover a
defect in this electronic work within 90 days of receiving it, you can
receive a refund of the money (if any) you paid for it by sending a
written explanation to the person you received the work from. If you
received the work on a physical medium, you must return the medium
with your written explanation. The person or entity that provided you
with the defective work may elect to provide a replacement copy in
lieu of a refund. If you received the work electronically, the person
or entity providing it to you may choose to give you a second
opportunity to receive the work electronically in lieu of a refund. If
the second copy is also defective, you may demand a refund in writing
without further opportunities to fix the problem.

1.F.4. Except for the limited right of replacement or refund set forth
in paragraph 1.F.3, this work is provided to you ‘AS-IS’, WITH NO
OTHER WARRANTIES OF ANY KIND, EXPRESS OR IMPLIED, INCLUDING BUT NOT
LIMITED TO WARRANTIES OF MERCHANTABILITY OR FITNESS FOR ANY PURPOSE.

1.F.5. Some states do not allow disclaimers of certain implied
warranties or the exclusion or limitation of certain types of
damages. If any disclaimer or limitation set forth in this agreement
violates the law of the state applicable to this agreement, the
agreement shall be interpreted to make the maximum disclaimer or
limitation permitted by the applicable state law. The invalidity or
unenforceability of any provision of this agreement shall not void the
remaining provisions.

1.F.6. INDEMNITY - You agree to indemnify and hold the Foundation, the
trademark owner, any agent or employee of the Foundation, anyone
providing copies of Project Gutenberg™ electronic works in
accordance with this agreement, and any volunteers associated with the
production, promotion and distribution of Project Gutenberg™
electronic works, harmless from all liability, costs and expenses,
including legal fees, that arise directly or indirectly from any of
the following which you do or cause to occur: (a) distribution of this
or any Project Gutenberg work, (b) alteration, modification, or
additions or deletions to any Project Gutenberg work, and (c) any
Defect you cause.

Section 2. Information about the Mission of Project Gutenberg

Project Gutenberg is synonymous with the free distribution of
electronic works in formats readable by the widest variety of
computers including obsolete, old, middle-aged and new computers. It
exists because of the efforts of hundreds of volunteers and donations
from people in all walks of life.

Volunteers and financial support to provide volunteers with the
assistance they need are critical to reaching Project Gutenberg’s
goals and ensuring that the Project Gutenberg collection will
remain freely available for generations to come. In 2001, the Project
Gutenberg Literary Archive Foundation was created to provide a secure
and permanent future for Project Gutenberg and future
generations. To learn more about the Project Gutenberg Literary
Archive Foundation and how your efforts and donations can help, see
Sections 3 and 4 and the Foundation information page at www.gutenberg.org.

Section 3. Information about the Project Gutenberg Literary Archive Foundation

The Project Gutenberg Literary Archive Foundation is a non-profit
501(c)(3) educational corporation organized under the laws of the
state of Mississippi and granted tax exempt status by the Internal
Revenue Service. The Foundation’s EIN or federal tax identification
number is 64-6221541. Contributions to the Project Gutenberg Literary
Archive Foundation are tax deductible to the full extent permitted by
U.S. federal laws and your state’s laws.

The Foundation’s business office is located at 41 Watchung Plaza #516,
Montclair NJ 07042, USA, +1 (862) 621-9288. Email contact links and up
to date contact information can be found at the Foundation’s website
and official page at www.gutenberg.org/contact

Section 4. Information about Donations to the Project Gutenberg
Literary Archive Foundation

Project Gutenberg™ depends upon and cannot survive without widespread
public support and donations to carry out its mission of
increasing the number of public domain and licensed works that can be
freely distributed in machine-readable form accessible by the widest
array of equipment including outdated equipment. Many small donations
($1 to $5,000) are particularly important to maintaining tax exempt
status with the IRS.

The Foundation is committed to complying with the laws regulating
charities and charitable donations in all 50 states of the United
States. Compliance requirements are not uniform and it takes a
considerable effort, much paperwork and many fees to meet and keep up
with these requirements. We do not solicit donations in locations
where we have not received written confirmation of compliance. To SEND
DONATIONS or determine the status of compliance for any particular state
visit www.gutenberg.org/donate.

While we cannot and do not solicit contributions from states where we
have not met the solicitation requirements, we know of no prohibition
against accepting unsolicited donations from donors in such states who
approach us with offers to donate.

International donations are gratefully accepted, but we cannot make
any statements concerning tax treatment of donations received from
outside the United States. U.S. laws alone swamp our small staff.

Please check the Project Gutenberg web pages for current donation
methods and addresses. Donations are accepted in a number of other
ways including checks, online payments and credit card donations. To
donate, please visit: www.gutenberg.org/donate.

Section 5. General Information About Project Gutenberg electronic works

Professor Michael S. Hart was the originator of the Project
Gutenberg concept of a library of electronic works that could be
freely shared with anyone. For forty years, he produced and
distributed Project Gutenberg eBooks with only a loose network of
volunteer support.

Project Gutenberg eBooks are often created from several printed
editions, all of which are confirmed as not protected by copyright in
the U.S. unless a copyright notice is included. Thus, we do not
necessarily keep eBooks in compliance with any particular paper
edition.

Most people start at our website which has the main PG search
facility: www.gutenberg.org.

This website includes information about Project Gutenberg,
including how to make donations to the Project Gutenberg Literary
Archive Foundation, how to help produce our new eBooks, and how to
subscribe to our email newsletter to hear about new eBooks.