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. In the mean time we may express our cordial approbation of the manner in which he has executed his present elaborate performance.

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

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science advances, and its cultivation is zealously carried on, so much the more will practical views and experience become the common property of all physicians who combine theory and practice; and that which was formerly regarded as the exclusive property of the medical pioneer will be open to all-will be almost the common stock of all who strive to obtain it.-P. 4.

The vast importance of chemistry, especially in relation to those numerous diseases which are connected with the fluids of the animal body, is generally recognised in the present day; but, owing principally to the difficulty of the enquiry, a custom has arisen of regarding this subject as belonging to a separate science to which the term "Pathological Chemistry" has been given. That this disseveration must retard the medical knowledge of many important diseases, is sufficiently obvious; instances of serious if not of fatal mistakes, arising from this cause, are not indeed of rare occurrence; and we therefore extract the judicious observations of the author respecting the practice just noticed.

"In the investigation of delicate points connected with pathological histology, the miscroscope is indispensable, and the application of chemical re-agents must be observed under it. Chemical analysis is, indeed, of the greatest importance to pathological anatomy, being the only means by which we can on several points obtain the desired information. At present, much to the detriment of the science, chemical investigation is little pursued in conjunction with pathological anatomy; but assuredly the time will soon arrive, when chemical analysis will be deemed just as indispensable to the prosecution of pathologico-anatomical investigations as the microscope is at present, and when every follower of this science will consider chemical analysis so essentially requisite, that if his own time and opportunities prevent him from carrying it out, he will employ a chemist, under his immediate guidance and direction, to undertake it for him."-P. 11.

The two great sources of accurate knowledge in pathological anatomy are, as the author affirms, observation and experiment; the former being the principal means of investigation as far as the human body is concerned; whilst the latter, for obvious reasons, is almost exclusively restricted to animals. It is hardly necessary to combat an objection frequently urged in former years, that the results obtained from pathological changes induced in the lower animals, are not trustworthy when applied to man. Two of the most ordinary phenomena presented to the notice of the practitioner, the reparation of fractured bones and inflammation, have been elucidated almost exclusively, as regards their essential characters, by experiments and observations made on living animals; whilst, as concerns the restorative process in wounds of the intestines and divided arteries although more has been learnt from the inspection of the human body than in the preceding instances, yet the most precise and satisfactory information has sprung from well-devised experiments practised on the brute creation. It is somewhat strange that this objection should ever have arisen, since no one could be found to deny that great light has been thrown upon many interesting branches of pathology by diseases occurring in the domesticated mammalia. For these reasons we are fully prepared to coincide with Dr. Vogel, that conclusions drawn from this source are not only admissible, but that comparative pathology and pathological anatomy afford as much assistance in the prosecution of this science in relation to man, as comparative anatomy does for the thorough comprehension of human anatomy and physiology.

1847.]

Proper Mode of Investigation.

431

But to give value to any mode of investigation, the facts must be multiplied and scrupulously weighed. Limited observations and hasty generalizations have been the special bane of medical science, not merely by leading to error, but by tending to throw discredit on the very means by which of all others the most assured results are to be attained. In short, that science, for such it is, in which so many of the great questions affecting civilized communities have found their solution, namely statistics, must be applied to that which lies at the bottom of all enlightened medicine and surgery-pathological anatomy. True it is, that to apply the statistical method to morbid anatomy, is a much more difficult matter than to determine the mean duration of human life, or the average age at death; for, as the author observes, in proposing as a problem the question whether scirrhus and tuberculosis exclude each other, "although physicians are not likely to dispute whether or not a man is really dead, there are few points on which there is more difference of opinion than whether a tumour is to be regarded as of a scirrhous nature or not." There are not then, at present, the data requisite to enable some second Newton to give to pathology its laws and principles; an additional reason this for all who are interested in the future progress of medicine to imitate our author. "In our science," he justly observes, "we must follow the examples set us by the astronomers, magnetists, and meteorologists (and he might have added the geologists), who continue for years to carry on the most careful general observations, and to make them public property, in the hope that the general laws which they fail to establish, will be developed by their successors. "—Introduction, p. 18.

In the volume now translated, Dr. Vogel treats only on the generalities of morbid anatomy; a second volume will follow, in which the special department, or that relating to changes in the individual organs, will be comprised; and, as Dr. Day has undertaken the translation of this concluding part, the English reader will soon be in possession of one of the most recent and complete treatises that have appeared in relation to pathological anatomy. Although we feel it but just to the author to speak thus favourably of his well-known work, we cannot withhold the expression of our opinion, that it is valuable rather on account of presenting a comprehensive epitome of the existing knowledge, than for the extent of original observation in reference to microscopy as applied to morbid anatomy. And further, this treatise, in which the new system of pathology is, without reservation, adopted, appears to us to be particularly deficient in the application of the great discoveries made of late years in structural and philosophic anatomy, and which must, for the reason just stated, be regarded as a fundamental defect: the justice of these remarks will, we think, become apparent in the course of the present article.

The general scope of this first division of the subject will be understood by the following sketch of the order, in which the different morbid changes are discussed.

"We commence with abnormal collections of fluids in the body-of the gaseous (pneumatoses), of the aqueous (dropsies). The latter are divided in a manner that seems natural and practically important, although not hitherto adopted; namely, into serous, fibrinous, and false dropsies. Then comes a sketch of the morbid changes of the blood as far as they are at present understood. This is