1847.] The Vital Forces-Haller. 415 chemical properties in common with inanimate matter. Different observers, however, attached different degrees of importance to these. "Some were especially attentive to the intrinsic force, studying with care its tendencies, and scrupulously following its indications: they were termed Hippocratists. Others, the Humorists, of whom Galen is the chief representative, had especial regard to the elementary qualities (heat, coldness, &c.) of the humours. Others, again, only took into account the physical qualities of the solids, and especially their porosity and the power possessed by the various tissues of dilating or contracting. These were the Methodists. The Empirics disdained all physiological considerations, in which they were wrong, as in so complex a study as that of disease we should avail ourselves of all the light any branch of science affords. They might, however, have thus addressed other sectarians:— You are aware that the phenomena of the animal economy are the product of three descriptions of forces, and yet you direct your attention exclusively to one of these, reckoning the others for little or nothing. But examine any function, the secretion of saliva for example—is it not evident that the vital, the physical, and the elementary or chemical forces, are here acting in unison? and who can say the exact part which each takes in the act? No one; and it is impossible to form an exact idea of the function as long as we separate by a mental analysis the forces which concur to its production. We must study it as it presents itself to our observation, synthetically and experimentally.' "At the revival of science the old physiological systems were re-produced under different forms. The Iatro-mathematicians, versed in the calculation of physical forces, professed to explain the functions of the economy by the laws of mechanics. They saw only in the circulation, the secretions, nutrition, &c., the effects of the elasticity of tissues, the size of vessels, the friction of their contents, &c. The Chemical Philosophers gave exclusive consideration to the mixtures of the chemical elements, and spoke only of acid or alkaline humours, gases, salts, fermentations, &c. The Hippocratists regarded only the influence of the intrinsic force of the living body which they named archæus, vital principle, &c. From this it is evident that physiologists recognised no difference between the properties of organized and inorganic matter; and, to explain certain acts of the economy, had recourse to the intervention of an immaterial or quasi-immaterial substance, as the soul, archæus, &c. They were ignorant of the vital forces properly so called."-Tom. II., p. 192. Towards the middle of the 17th century, however, Francis Glisson admitted in the living solids a special force, with which all tissues are endowed in different degrees, and which he believed sufficed to explain all the vital phenomena. This he termed Irritability. His views were neglected and forgotten for more than 60 years, when they were revived by De Gorter. Irritability was, however, confounded with elasticity, until Haller (1747), by a series of most ingenious experiments, raised Glisson's hypothesis into an established fact; and clearly defined the differences between this vital contractility and mere contractility of tissue. Between 1757 and 1766 he published his unrivalled Elementa Physiologia Corporis Humani. 66 Throughout the whole of this work he proceeds with his ordinary circumspection, advancing nothing that is not capable of support by well-ascertained facts, and according to hypothesis the smallest possible space. Rich in a multitude of original observations, and displaying a vast erudition, this work constituted an imperishable monument in the science of life. Dating from this epoch, physiology claims a separate existence from physics and chemistry, it having been demonstrated that life has its laws and special forces, which must be studied in an entirely peculiar manner."-Tom. II., p. 194. The truths proclaimed by Haller keenly attracted the attention of the learned. Fontana was one of the most skilful of the defenders of the new doctrines, and Bordeu applied them to the explanation of the secretions, the variety of which he attributed to the specific sensibility of the different glands. Fabre first applied them to pathology in refutation of Boerhaave's mechanical theory of inflammation. "Haller had only demonstrated the existence of irritability in muscular fibre. His disciples admitted the property in other parts; but its existence in every tissue had yet to be proved by experiment and severe analysis. Its forms and degrees had yet to be exhibited-in a word, the theory of the vital properties required systematizing and extending to every function; and this task was undertaken with as much genius as boldness by the celebrated Bichat." In the mean time, Hunter's beautiful experiments had fully established the vital properties of the blood; and various other writers had contributed to the progress of anatomy and physiology during this period, especially Winslow, Albinus, the Monros, Douglas, Vicq d'Azyr, &c., &c. 2. Hygiene. During the period we are now occupied with, the subject of Hygiene much engaged the attention of physicians, philosophers, and statesmen. Its consideration is divided by M. Renouard into two sections, the one treating of Public Hygiene, the other of Personal Hygiene. Under the first of these headings he passes briefly in review the gymnastic exercises of the Greeks, the architectural contrivances of the Romans for securing the salubrity of their towns, the leper hospitals of the Middle Ages, and the establishment of lazarettos in the 17th century; he adverts to the improvements in the health of prisoners, soldiers, and sailors, which have resulted from the labours of so many philanthropists and physicians; and, lastly, gives some account of the discovery of vaccination by Jenner. Among the works on Personal Hygiene which the period produced, the "De Mediciná Statica Aphorismi" of Sanctorius, in which he details the elaborate series of experiments he performed upon the transpiration of the body, deserve especial mention from the celebrity they acquired. "This publication was received as a revelation, a true code of hygienic laws. Its author was saluted as a second Hippocrates, and his sanitary maxims placed on the same level or above those of the old man of Cos.' His salary as professor at Padua was continued to him after he had quitted Padua, and a statue was erected to him at Venice, where he died in 1636. "Yet, if we submit his work to severe criticism, we find it faulty in several respects. His conclusions are too general and absolute; for, from experiments made upon one individual in one climate, he draws inferences to be applied to every person in all kinds of climates. Moreover, many indubitable sources of error were mixed up with his calculations. Thus, he makes no account of the pulmonary exhalation or absorption or of the cutaneous absorption. Lastly, many observers in different countries having repeated Sanctorius's experiments, have obtained very variable results. Whence it appears that there is nothing so mobile as the cutaneous transpiration, and that the design of estimating its quantity is, as Bichat says, as vain as to pretend to specify the volumes of water which are hourly vaporized from a source whose energy is varied every instant. The only general conclusion we can draw from these experiments is, that in the state of health this excretion is ordinarily very abundant, that it diminishes in old age, 1847.] Progress of Pathology-Morgagni. 417 and that in all cases it merits the attention of the physician as well as of the physiologist. If, therefore, the Aphorisms' do not justify the enthusiasm their appearance excited, neither do they merit to be so utterly neglected as they are at present. Boerhaave, whose opinion should carry some weight, declared that no other medical work was so perfecily executed; and Lorry has added commentaries to it worthy of perusal at all periods."-Tom. II. P. 210. The works of Cheyne, Fischer, Rammazini, Lorry, Juncker, Beddoes, Hallé, Tissot, Sinclair, &c., &c., were also among the most celebrated of those devoted to hygiene appearing during this period. 3. Pathology. "Pathology, during this period, was viewed under very different aspects, which we can only here summarily indicate, as we shall have to speak of them more at large when treating of the various theories. Some made the humours play the principal part in the generation of disease, conformedly to the modified Galenical doctrines, or of the new chemical ideas; others only saw in every morbid disorder some error or disturbance of the regulating principle of the economy which they termed archæus, soul, nature, vital principle, &c.; others considered diseases as a dynamical derangement of the action of the solids; and, lastly, some rejected all consideration of causes and phenomena which did not fall within the cognizance of the senses, and decided to confine themselves to simple observation. From these different modes of viewing diseases, very varied pathological classifications resulted, and in the end a much more profound and complete acquaintance with morbid conditions.”—Tom. II. p. 213. Semeiology.-Several physicians of this period made some one symptom the subject of special and abstract study. The variations in the amount of transpiration especially occupied the attention of Sanctorius, and several other observers paid the same minute attention to the conditions of the pulse. Among these, Bordeu endeavoured to attach all the shades of health and disease to certain determinate varieties of it, creating in this way endless subtle distinctions, of doubtful reality and of no practical value. At about the same period (1761) Avenbrugger published his work upon Percussion, but which met with little attention, until translated and commented upon by Corvisart, in 1808. Pathological Anatomy, from the commencement of the 17th century, made rapid strides, under the guidance of Bartholin, Tulpius, Ruysch, &c.; and the now immense number of observations were collected, examined, and classified by Bonet, in his Sepulchretum, published at Geneva, in 1700, an imperfect and confused work, but which, however, furnished the idea of his Anatomico-pathological Letters to the immortal Morgagni, published in 1762. "In fact, he only proposed to himself, in composing these Letters, to amend, and in some sort refound, this work of Bonet. Profiting by the riches which science had acquired in the interval, and especially by those which his master, Valsalva, had amassed, and joining to these an extensive erudition and a severe critical spirit, he established order and clearness where the author of the Sepulchretum had left confusion and darkness. He showed himself original without having the pretension of being so, contrary to so many others who possess the pretension without the reality. He disguises nothing that he borrows, whether from the dead or the living; but what he borrowed from no one was the selection and judicious employment of his materials, and the wise and luminous discussion of facts. Persuaded that medical science can only progress by the light of obser vation, he scrupulously avoids losing himself amidst vague interpretations; so that the idea quoted from the Odyssey in his preface may not be applied to himself, He has told much untruth in relating what is seemingly true."-Tom. II. p. 221. From the period of the publication of Morgagni's" Epistolæ," in 1762, to the end of the 18th century, a great number of enquirers diligently occupied themselves in anatomico-pathological researches, as Walther, Sandifort, W. Hunter, Greding, Lieutaud, Portal, and, above all, Xavier Bichat. 66 Uniting to a genius eminently adapted for generalizing, an admirable talent for observation and analysis, he shed not only on pathological anatomy but on entire pathology a bright light, whose rays guided the labours of the majority of his successors. The idea of decomposing the animal body into elementary tissues, which present in every part where they are found the same properties, and are liable to the same changes, has been the parent-idea which, for sixty years, has served as the basis of the researches of pathologists."-Tom. II. p. 222. Nosography. Although the Hippocratic writers acknowledged the division of diseases into epidemic, endemic and sporadic, and into acute and chronic, yet they did not always observe this very strictly; and it was only after the foundation of the Alexandrian School, and under the influence of the peripatetic philosophy, that any attempt at a systematic order was observed. Diseases were divided into external and internal, general and particular. The general diseases were supposed to affect the entire economy, without having any determinate seat, as fever, gout, syphilis, poisoning, &c., while the particular diseases were seated in one of the three great cavities of the body. To the classification of the Methodists we have already alluded. That introduced by Plater, at the end of the 16th century, does not seem to have exercised much influence, as, long after, writers upon medicine, such as Morgagni, Sennertus, &c., still followed the ancient methods. Towards the end of the 17th century, naturalists had made great progress in the classification of the objects of their studies, and Sauvages, a young physician of Montpelier, after consulting with Boerhaave, published, in 1732, his Nosology, constructed upon the principles recognised by the botanists. It excited little attention until some thirty years after, when its author, having revised and enlarged it, republished it as his Methodic Nosology. It then acquired the highest renown, in proof of which, it was the only work employed by Linnæus in his lectures at Upsal for twenty years. "Whatever discredit this description of works may have fallen into in our times, the Nosology of Sauvages will always worthily employ the attention of those who like to follow the progress and development of a science so difficult as pathology. Besides forming the first of a series of interesting productions, it offers the most complete collection of descriptions of disease, and observations collected from all sources, hitherto published." Our own Sydenham had long before expressed his desire that a history of diseases might be written, disengaged from all hypothesis, in which the only object should be the exactly tracing the sensible phenomena and the distinguishing morbid species by their constant and essential symptoms. But although Sauvages entertained the highest veneration for him, terming him the glory of England, and the light of our art, he was far from strictly 1847.] Nosological Systems—Therapeutics. 419 following his counsel, too often mingling with his histories of disease vague theories and hypotheses concerning their causes and nature. When his System, too, was more calmly examined, it was found that the multitude of genera and species he had created tended only to induce confusion in diagnosis, not being separated from each other by sufficiently well-defined and constant symptoms. Numerous physicians endeavoured to improve upon his plan, but it was not until the Nosology of Cullen (1785) appeared that any true progress was really made. "This much reduced the number of species, and distinguished them by better defined and less variable characters. It presented then a real improvement upon that of Sauvages, and obtained a universal vogue, which it maintained until the publication of the Nosographie Philosophique of Philip Pinel, in 1798. This eclipsed all the preceding ones, and soon became classical throughout Europe. Six editions within twenty years testify to the confidence it has enjoyed." Pinel divided diseases into six classes, 21 orders and 84 genera. His classes are-1, Fevers; 2, Phlegmasiæ; 3, Active Hæmorrhages; 4, Neuroses; 5, Diseases of the Lymphatic and Dermoid Systems; 6, Undetermined, comprehending genera which are not sufficiently connected to link into general orders. In the last edition, the two latter classes have been reduced to one, under the title of Organic Lesions. 66 Sprengel, writing at the commencement of the 19th century, speaks of Pinel and his Nosographie in the following terms: Faithful to nature and experience as Hippocrates, whom he constantly takes as his model, and formed by the study of the best works on medicine at all periods, Pinel has taken his place among the most skilful and learned physicians of our times. His work is a true masterpiece, as much from the excellent plan he adopts as from the depth and impartiality of his judgments."-Tom. II. p. 234. Besides the Nosologies adverted to, others were published by Linnæus, Vogel, Macbride, Sager, Darwin and others: but these require no specific notice, as possessing no authority. "Sauvages and all the other nosologists, not excepting Pinel himself, although approving of Sydenham's advice, of recording only the constant phenomena and sensible characters of disease, all fall more or less, under some pretext or other, into the error of occupying themselves in searching for the occult causes of disease." The Precis de Medicine of Lieutaud is cited as a remarkable exception to this stricture. "The mere avoidance of hypothesis, however, will not alone constitute a good nosology. Exact and detailed descriptions of each morbid species is a primary requisite. Too brief descriptions engender obscurity, which after error is the greatest defect in this kind of work. Classifications may vary without end, depending as they do upon the manner in which an author views his subject, and diseases, being very complex objects of study, may be viewed from many points of observation. But descriptions of each morbid species, when well made, preserve their value independently of all changes in classifications and systems; this has occurred to the histories of Hippocrates, of Aræteus, of Alexander of Tralles, and of all great observers.”—Tom. II. p. 338. 4. Therapeutics. The old and erroneous maxim of the remedial agency of the contraries was revived under new forms in this epoch, during which, also, various new |