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were in this sweeping code of medical principia referred to sheer weakness or deficient excitation, and all medicine was mere stimulation; the lancet was denounced as an instrument of destruction, evacuations were proscribed upon pain of death, and all organic affections from the crown of the head to the sole of the foot, were viewed and treated upon the bold and broad principle of general excitation.
It soon, however, became evident, that debility and disease are not quite such simple states and requirements as these doctrines taught us to believe, and that local irritations, and organic conditions, demand some cognisance both in pathology and practice. Now, then, by a kind of reaction came into play and repute the visceral notions; and the only difficulty was, to determine what particular organ to fix upon as the root of the evil. The largest, and one of the most important of all the viscera, namely, the liver, naturally put in its claim for priority of consideration, and was soon voted into the vacant chair. Hepaticism henceforth ruled the roast. Peruvian bark, and opium, and steel, and all kinds of tonics and specifics, were pushed faraway into the back ground; and, as we have just seen, whether an infant was dying of water in the head, or an adult was enduring the agonies of gout in the great toe, no other part of the frame, excepting the liver, had any share or lot in the matter.
But I must hasten to the second head of division above proposed, and am now, therefore, to trouble you with a few remarks upon that system of medicine which I have elsewhere named " a modification of this hepatic mania." The peculiar views of the principal abettor of this system were occasioned in some measure by the circumstances of hospital practice, and by the contrast which our ingenious and able physiologist observed between the complaints of local or " surgical affections," when the subjects of them were crowded into hospitals, and the same disorders in separate apartments, and in purer air. The foulness of the tongue, the irregularity of the excretions, and the attendant depression under these circumstances, led the speculatist in question to the formation of a body of medical principles, the substance of which may be summed up in a very few words; namely, that our notions of specific deseases and specific remedies, are founded on false assumptions; that even strength and weakness are merely states in reference to the condition of the first passages; and that if the practitioner can but succeed in procuring a regularity and orderly performance of the digestive functions, every thing else falls into order by course and consequence. It is the property of genius to do a great deal with slender means. Brown must have been surprised at the extensive spread of doctrines which he propounded in personal pique; and, very probably, at least in the first instance, gave no credit to himself; and in like manner, Mr. Abernethy must wonder to see the champions of his chylopoietic principles planting themselves in every corner of the land, and singing poeans of praise to their first promulger. Simple and slight as the above propositions appear to be, and really are, they have, nevertheless, influenced to such an extent the medical opinions and practice of this country, as to have operated a thorough change both in our theoretical notions and practical views. That this is not an overcharged statement, may be gathered from what is immediately to follow. A very little more than twenty years since, a German physician, having paid a visit to England, expressed himself in the following terms on the subject of British medicine:—
"From infancy the English are brought up in bodily activity, cleanliness, and the enjoyment of fresh air. Their nourishment is strong, consisting more of solid roast beef, with spices, strong beer, and wine, than of soups, vegetables, and weak liquors. Even their methods of cure are more vigorous, though not always more proper; and the use of neutral salts and purgatives, so common in Germany, is much less so there. Hence there is a greater energy in the phenomena of the powers of life; hence fewer gastric complaints; hence the English support much stronger doses of stimulant, hot and active medicines, than we dare think of in Germany. The rheumatic constitution is almost endemic; but we must not forget that the English understand by this term, every kind of pain in the limbs, even obviously gastric affections. The author saw, in a case of pain in the pericordia and shoulder, which proceeded evidently from gastricity, a blister applied to the nape of the neck. Next to rheumatic complaints, consumption and dropsy are most frequent; but their treatment is quite empirical with specifica etheroica, without a plan of cure or due indication. Mercury is liberally employed, (he goes on to inform his readers,) and opium is notoriously a common remedy. It is not credible how it is lavished and misused. As in Germany it is customary to add to a recipe already answering every indication, a little syrup or cinnamon water; in England, so much laudanum is added." The third great remedy (our German critic adds) is the Peruvian bark. From the year 1788 till 1793 there have been imported into Britain 634,783 pounds, without reckoning what may have been smuggled. Now, if we deduct 123,700 pouuds, which have been exported, there still remain half a million of pounds used in the country itself. The causes of this extensive use of it are, beside the real excellence of the remedy, the natural tendency of the physicians and people to believe in specifics and miracles, the authority of former great practitioners, and the great scarcity of gastric diseases, as well in reality as in the heads of physicians."
Now, so far from there being any present lack of " gastricity in the heads of physicians" of this country, there are those among us, and that not a few, who will laugh you to scorn if you theorise upon the production of any disease without beginning and ending with the "digestive organs." This, they say, is the grand mainspring of every thing, for which we have been groping in the dark for more than two thousand years : and for want of which the whole machinery of medicine has, hitherto, been going wrong. Let us enter an infirmary, and mark the multifarious forms which disease assumes. In one corner of a ward you see a child with a scrofulous affection of the hip joint; you observe that the disorder, commencing perhaps in the ligamentous parts, has extended itself among the muscles and membranes, and threatens, nay, has almost accomplished its threat to destroy the joint that it has attacked. Anticipating the event, you pity the destiny of the individual; but your anticipations are erroneous; your pity is misplaced; it is not in the hip, but in the stomach, that the disorder lies, and by a little regulation of the chylopoietic and assistant chylopoietic viscera, crooked things and curved limbs will soon be made straight. There is another individual with an obstinate inflammation in his eye: obstinate hitherto, because it has been injudiciously treated as an actual affection of that organ, which is seemingly the seat of the malady, but, know sir, the disease is deeper seated; the great sympathetic nerve, the gastric membranes, are the organs in fault. We shall staightway commence our operations upon these, and the almost "blind will soon be restored to sight." That ward of yourbuilding, it is presumed, from its name, is devoted to the reception of venereal cases. Venereal cases! what an absurdity! Does Aretaeus, does Celsus talk any thing about this modern bugbear, this unnecessary preventive of innocent pleasures, the lues venerea? Stotnach cases you mean; and with a due use of alteratives, and sarsaparilla, we shall soon empty the apartment of its present occupants. Are rheumatic affections very frequent with you? We are not aware of the import of your question. Rheumatism with us is a name without a meaning: we meet, indeed, often with many muscular and membranous pains, which yield easily to sulphate of magnesia and blue-pill: but all these are mere instances of gastric irregularities. Pulmonary consumption, it is presumed, still continues its ravages? It does so, but it is because gastricity has not yet sufficiently established its ascendancy over the minds of medical practitioners. When the faculty shall have come duly and universally to appreciate the importance of regulating the stomach and bowels, our consumptive wards can be turned into committee rooms, where we may meet to triumph in the prevalence and success of the gastric faith!
It has been unhesitatingly asserted by one writer, that Mr. Abernethy's discoveries have been the only real improvements in medicine since the time of Hippocrates. In like manner, it will be recollected, that Brown was by many hailed as the Newton that had at length appeared and brought with him a flood of light and day. Indeed, this last author was modest enough to make this eureka declaration for himself, "quasi prima diurna," he tells us, " lux demum adfidsit." And again, in the masterly preface to his elements, which wants nothing but truth to make it one of the most admirable compositions that ever was penned, he propounds the following question with an air of triumphant exultation: An igitur ars conjecturalis, sibiparumconstant, et longeplerisque sui partibus falsa, in Certam demum, qua vita dicipossit, sci Entiam est redacta t
On the score, Gentlemen, of the last set of principles to which I have alluded, I feel myself placed in a situation of somewhat more difficulty and delicacy. There seems to be a more intimate admixture of truth, and what I conceive to be error, in the vascular than in the ventricular theories: and most certainly the doctrines of this school are not so vulnerable to the shafts of ridicule as in the cases upon which I have above endeavoured to comment.
Were I to aim at designating those views of medicine upon which I would now venture one or two brief strictures, I would do it by a very simple illustration : let us suppose an individual to be affected with febrile lassitude, connected with headach, and that general depression of the animal faculties which characterises the state lit question. What is the precise condition of the bodily organisation under these circumstances? I am told in reply, either vascular congestion or increased momentum of the circulating fluid, the result of general plenitude. But I often see marks and indications of quite as much fulness, and even of local determinations, without such plethora and topical momentum bringing with them that oppression and derangement of the animal faculties which is observed in the adduced instance. Hence I infer that something beyond the blood vessels has been originally at fault, and that this something requires to be particularly recognised both in pathology and plans of treatment. Now it does, I confess, appear to me that some of our ablest pathologists, and most accredited writers of the present period, have too much lost sight of the affections of the sentient organs and primary moving powers, in their wish to dwell upon inflammatory and congestive states, as explicatory of all morbid phenomena. It is curious to observe, how the doctrines of the vascular speculatists, if I may use the terms, have, like the stomachic and hepatic tenets, arisen by a kind of spring and reaction from the downfal of the Cullenian principles of spasm ; and how determinate a spirit is evinced in the new converts to get rid of every relic of the ancient superstition. Determinations of blood now take place of the antiquated notions of nervous irritation; and it is really too largely inferred, that the essence of all disease, the alpha and omega of every sort of derangement, pulmonary or ventricular, muscular or mental, consists in nothing else than disturbed and irregular circulation. Cough, for example, I have heard it contended, can in no case be constituted by any other circumstance than some kind of pulmonic inflammation, or at least congestion. Spasmodic cough, says a rigid theorist of this school, is to me a term importing nothing. But how can this postulate be reconciled with the fact frequently observed of sympathetic irritations of the pulmonary organs being made to cease with the facility of a charm, by the removal of the cause out of which the sympathetic disturbance had grown. Destroy or expel half a dozen ascarides from the rectum, and you will sometimes, by so doing, cure at once a protracted and troublesome cough, without detracting a particle of blood, or in any other way lessening the momentum of this fluid, than by diminishing the nervous irritation, from which, if present, the vascular excitement had proceeded. 1 say, if present, since I cannot help adopting that heretical creed which supposes the possibility of a great deal of occasional disturbance and irritation, without even the consequential presence of inflammatory or congestive states. For the propriety of the term spasm, as applied to the conditions now conceived, it would be far from my wish to argue. It is not the word, but the thing signified by the word, about which it is important to have accurate notions: and without further enlargement, it will readily be inferred as my opinion, that in opposing the gratuitous and frequently erroneous assumptions of the spasmodic theorists, we have urged the resistance, not merely to the extent of pushing away the opposition to truth, but have fallen prostrate by the weight of our own powers, upon the recession of the obstacle. At one time it seemed to be nearly lost sight of, that there were such things at all as blood vessels: it now, by some appears to be almost forgotten, that there are powers in animal and intellectual organisation, which impel and impede, urge and control, the vascular action.
As 1 have accidentally fallen upon deranged states of the pulmonary organs, with a view to illustrate the tenets it is now my wish to inculcate, it may not be irrelative to introduce the sentiments of the venerable Heberden on the particular head of asthma. This author, who was the advocate of no system beyond that supplied by actual observation, remarks, when treating on the cause of the disease m question, that " if we advert to the comparatively little disorder which dissection sometimes displays in the lungs of individuals who have died of this malady; if we take into our estimate ofcircum