1847.] Iatro-Chemistry and Iatro-Mechanics. 425 most difficult problems were revealed to him. Nor is it astonishing that he often substituted hypothesis for hypothesis, error for error. The observers of that period were, in regard to many questions now well understood by us, in the same condition we find ourselves in with respect to other difficulties insoluble by our modes of investigation. What theory have we to offer in explanation of the cure of ague by bark, the origin of variola, or the destruction of its germ by vaccination? Who of us has not made his vain efforts to penetrate obscurity, and plunge beyond the horizon? Well! Let us then cast a glance back at that past which was then future, on our lights which were then darkness, and we can picture to ourselves the false glare and gropings of our predecessors-all the more ready to lose themselves, as unpossessed of that compass we have-the method of observation-inasmuch as, in the absence of facts, they could scarce abstain from hypotheses."-Tom. II. p. 378. Iatro-Chemistry.-The Chemist-Physicians. Francis Leboe, surnamed Sylvius (1614-1672), the first Clinical Professor at Leyden, and a great cultivator of anatomy and chemistry, first employed the laws of this last science for the exclusive explanation of the animal economy. Borrowing the idea of the agency of ferments from Van Helmont, he does not employ the intervention of his archæus or governing principle. The saliva, bile, and pancreatic fluid, from the active parts they play in the economy, are termed the triumvirate, and through their agency the various fermentary processes are gone through. Professing to found his views entirely upon observation, he is continually assuming what is not proved, and explaining what is not understood. Disease, according to his views, consists in a vitiated or acrimonious condition of these various fluids, and is best treated by purgatives, narcotics, and the abundant use of volatile alkalis for the correction of morbid acidity. Thomas Willis, (1621-1625,) our countryman, and the author of so excellent a work upon the brain, basing his views upon the same chemical foundation as the Leyden professor, even surpassed him in gratuitous hypotheses. From the igneous analysis of bodies he concluded there were five elements, spirit, sulphur, salts, earth and water, and endowed these with qualities as fanciful as the ancients attributed to theirs. The various organic apparatus of the economy, by virtue of special ferments with which they are endowed, are enabled to produce the requisite proportions of these different elements; and it is through the faulty operation of such fermentations that disease is generated; so that the physician has little else to do than watch such operation and remove obstacles from its due performance. Remedies act upon the spirits or the humours, exciting or modifying their fermentory motions in a thousand manners, thus producing various effects upon the system, and secondarily modifying the condition of the solids. Iatro-Mechanics.-The Mechanical Physicians. As the progress of chemistry gave rise to the attempt at explaining the functions of organized beings by the same laws which regulate the elementary combinations of inanimate matter, so that of mechanical and mathematical science suggested the application of calculation to the elucidation. of the same phenomena. Sanctorius, by his experiments upon transpiration, led the way in this new description of research; but Alphonso Borelli (1608-1679) was the true founder of the Iatro-mechanical Sect. He published several essays bearing upon the subject; but his great work De Motu Animalium, did not appear until the year after his death. * * * "The fruit of patience and genius, this work created a new branch of medicine. Until then, very vague and erroneous ideas prevailed as to the amount of force expended by animals during their various movements, and the manner in which it was applied. Setting out from the principle that Nature attains her ends by the most simple means and the most direct road, it had always been believed that man and animals were so constituted as to be able to execute the greatest movements and bear the heaviest burthens whilst employing the least possible power. Borelli overcame this prejudice by reasoning founded upon anatomical research and the laws of statics. Comparing the bones brought into play by the muscles to cords set in motion by levers, he proved that man expends an enormous amount of force during his movements. * However much some of his calculations may be wanting in exactitude, and accepting them only approximatively, it is still demonstrated that man develops, during his movements, an incomparably greater amount of muscu lar energy than the obstacle he has to overcome-a truth which was far from being suspected prior to the time of Borelli. His book contains also a prodigious quantity of observations as minute as new, upon the various modes of progression and the postures of animals. To cite one example of a thousand, he furnished a very ingenious explanation of the manner in which a bird supports itself upon one foot while sleeping, and that upon a branch of a tree which every breath of wind puts into motion.”—Tom. II. p. 393. * * Really possessed of as little foundation as iatro-chemistry, Borelli's mechanical explanations of all the healthy and diseased phenomena of the economy, seemingly supported by anatomical facts, minute hydraulic calculations, and the recent microscopic observations, obtained, by their apparent mathematical exactitude and simplicity, the suffrages of numerous enlightened observers. No such precision of ideas had been attempted since the porous tissues and various shaped atoms of the old Methodists. Bellini, Baglivi, Sauvages, Senac, Boerhaave, Bernovilli, Pitcairn, Keill, Freind, and Mead, were among those who accepted them with more or less modification. Of these, M. Renouard confines his attention to Baglivi and Boerhaave. George Baglivi (1668-1706), surnamed the Roman Hippocrates, endeavoured to extend the application of Borelli's ideas to pathology and therapeutics. Believing that the prevailing sects paid too exclusive attention to the condition of the humours, he set himself the task of proving that in all conditions of the economy, whether of health or disease, the solids are of predominant importance. Like the Methodists under Themison, he admits of only two classes of affections of the primary fibril, viz. too great tension or constriction, and too great softness or relaxation—the strictum and laxum. But Baglivi's theories are not his only claim to our notice; for he produced an admirable work on practical medicine, in which he insists upon our taking observation as our guide, sacrificing theory to experience. We no longer see merely the great opponent of the old humoral pathology and parent of modern solidism; but the enlightened practitioner, admitting that in chronic disease there may be a cocochymia or vitiation of the humours. 1847.] Aneurism and Vitalism-Stahl. 427 Hermann Boerhaave (1668–1738), endowed with a vast and subtle intellect, and profoundly versed in the writings of the ancients and the labours of the moderns, conceived the idea of uniting in one body of doctrine the various theories of medicine. Like Galen and Fernel, he was an Eclectic, but, inasmuch as mechanical explanations predominate in his writings, he has been classed with the Iatro-mathematicians, just as they were with the Dogmatists. He published his Institutiones in 1708. Their physiology consists of a most skilful amalgamation of anatomical, physical and chemical ideas. Unlike Baglivi, however, he did not, in the practice of his art, abandon his speculations for observation, and never seems for an instant to have doubted their exactitude. After the death of this celebrated man, the iatro-mechanical doctrines rapidly fell into obscurity, from which historians of physiology have only revived them. Animism and Vitalism. At the very time when the celebrated Leyden professor was spreading far and wide his mechanico-chemical theories, the newly-founded school of Halle was producing observers whose systems were speedily destined to overthrow these. George Ernest Stahl (1660-1734), conferred a vast benefit upon the study of the science of life, by recalling the attention of its votaries to the contemplation of the effects of the vital powers upon the economy in health and disease. The chemists had presented their ferments as the essential phenomenon of life, which the mathematicians placed in the contraction of the primitive fibre; but Stahl makes it consist in the preservation of the integrity and due mixture of the humours of the body through the immediate agency of the anima or immaterial soul. This agency he endeavours to prove by two arguments: first, that the body has been only created as the mere instrument through which the soul might operate; and secondly, that motion, by which alone life is maintained and its actions carried on, is a spiritual, not a material act. Unstable as is this hypothesis, it has the merit of greater simplicity than some of its predecessors, which its inventor ridicules with the bitterest irony. It is, in fact, but a modification of the archæus of Von Helmont, and did good by recalling attention to the study of the vital, as distinguished from the mere mechanical, phenomena then in vogue. Every pathological condition, according to Stahl, resulted from the re-action of the anima against the morbigenous principle; and as the symptoms of disease but represented the regular succession of a series of vital movements designedly excited by a reasoning agent, the office of the physician became reduced to that of a mere spectator of the sufferings of the patient, since active interference on his part might only derange some of the combinations of this supreme regulator of the economy. The iatro-chemists and mechanicians had too much lost sight of the great power which nature possesses of rectifying the derangements of the economy, just as the Stahlians grossly exaggerated it. Out of Germany the doctrine of Animism made but few converts, and in France that of Vitalism, as advocated by Barthez, of Montpelier, was far more generally received. This recognised the agency of the vital principle, much more resembling the archæus of Van Helmont, than did the anima of Stahl, distinct from the body or the immaterial soul, and yet endowed with feeling and perception. Organic Dynamism, (Vital Power resident in the various Organs.) Another class of physiologists believed the vital forces to be inherent in the respective organs, and occupied themselves in studying the laws of their operation. Hoffman (1660-1742), who first set the example of this simpler mode of viewing the economy, regarded disease as resulting from a perverted condition of the vital movements, too great contractility inducing spasm, and too feeble relaxation. These movements of the organic solids were, however, considered by Hoffman but as effects of the elasticity of structure; and Cullen (1712-90), was the first who applied the results of the researches of Haller upon the contractility and irritability of tissues to the construction of a medical theory, assuming irritability as a primary fact, the origin of which it were futile to search for. Hoffman regarded an anormal afflux or reflux of blood as the primary instrument of tension or relaxation. Cullen sought the point of departure in the nervous fibrils. Both, however, were admirable practitioners, and, notwithstanding their partiality to solidism, admitted of medicines calculated to act upon the humours, and frequently exhibited the therapeutical indications derived from the observation of the apparent phenomena with remarkable clearness. John Brown (1735-88) attempted to build upon a portion of Cullen's theory a most fallacious and dangerous system. He made health consist in the maintenance of a normal amount of excitability, disease being of a sthenic or asthenic nature, accordingly as this is in excess or defect; and, as he considered the vast majority of affections to be of a hyposthenic character, the exhibition of active stimuli constituted his principal therapeutical agent. Revival of Rational Empiricism. The partisans of the ancient medical sects, however much they differed among themselves, united in opposing the experimental methods of the Empirics, which so tended to sap the very foundation of hypothetical reasonings. The consequence was that universal odium and neglect befel these enquirers, who were really in advance of their age, and it has not been until recent times that their principles have been avowedly adopted. The progress of the Inductive philosophy should seem to be highly favourable to their reception; but, through prejudice and the abstruse nature of medical science, and the difficulty of discerning in it the reality of experimental deduction, the bearing of medical enquirers during the Reformatory Period towards Empiricism was most uncertain and contradictory. "It would be easy to exhibit such contradictions in the writings of Torti, Sydenham, Stahl, Morgagni, Sauvages, Cullen, Barthez, Pinel, Frank and others, in all of which we find the maxims of experimental philosophy adopted and proclaimed, and yet the name of empiricism discarded and denounced." We regret our inability to follow M. Renouard through his interesting exposition of the recent triumphant progress (especially in Britain) of the principles of Rational Empiricism. Indeed, notwithstanding the length of this article, we have been compelled to pass over the last chapters of the work in a very hurried manner; and, entirely analytical as our notice has been, we can find no room for any comments or criticisms it suggests. These must be reserved until the publication of the Supplement, in which M. Renouard proposes to sketch the doctrines of the 19th century. the mean time we may express our cordial approbation of the manner in which he has executed his present elaborate performance. In 1847.] Vogel's Pathological Anatomy. 429 THE PATHOLOGICAL ANATOMY OF THE HUMAN BODY. By Julius Vogel, M.D., Professor of Clinical Medicine at the University of Giessen. Translated from the German, with Additions. By George E. Day, M.A. & L.M., Cantab., &c. Illustrated with one hundred plain and coloured Engravings. London, H. Bailliere, 1847. THE editor of the French translation of Dr. Vogel's Pathological Anatomy justly observes, "in the age in which we live, value is only attached to that which is productive of positive and fruitful results. Medicine has not been able to escape this practical tendency, and hence, showing itself. less curious than formerly in abstract speculations, it has converged more than ever towards the final end of all its efforts-the perfectioning of the art of curing." It may not to some persons appear very clear that a work, in which histology, microscopy, and chemistry play a conspicuous part, obeys the impulse to which we have referred; and yet no one who reads the treatise before us can doubt that it is eminently practical. It is not because many new terms, and especially since the researches of Schwann, Henle, and other observers of the same class, have been introduced, that morbid anatomy and pathology have changed their essential character; on the contrary, the objects pursued now, and the results aimed at, remain the same as in the days of Morgagni and Baillie; the means of investigation alone have been altered with the advance of science, and with that advance, it may be safely affirmed, the modes of enquiry have become much more effectual, and the knowledge obtained, consequently, much more satisfactory. If it ever was a point of moment to form a natural classification of tumours; to distinguish definitely malignant from non-malignant growths; to detect in what consists the essential character of scirrhus, fungus, and other reputed specific formations; and more than all this, if at any time it concerned the physician to know what is the series of structural changes inducing the morbid actions it is his office to control and remove, then is pathological anatomy, as now cultivated, a subject deserving the careful study of every enlightened practitioner. In the introductory portion of his work, the author has with much judgment shown the limits, the objects, and the appliances of the important subject he so ably discusses. In tracing the relations of pathological anatomy with the individual branches of medical science, and after condemning the opposite but equally mischievous errors of an overweening confidence and an undistinguishing scepticism, Dr. Vogel proceeds to say: 66 “Above all, we must not be led away by such phrases as practical views,' and medical experience'-terms of common use, and too often conveying an erroneous impression. The practical views of the physician are the result of a series of accurate observations elucidating the treatment of disease. The true physician may be distinguished from the empiric by this, that the latter is more or less unconscious of the grounds on which he acts; and if the experience of the empiric seems in some few cases to be more successful than science, it can only be referred to a fortunate chance directing to the right point, and probably not based on the conscious experience of a single case. In proportion as the No. 108 28 |