210

CRITICAL ANALYSIS

OF RECENT PUBLICATIONS,

IN THE

DIFFERENT BRANCHES OF PHYSIC, SURGERY, AND MEDICAL PHILOSOPHY.

A Physiological System of Nosology, with a corrected and simplified Nomenclature. By JOHN MASON GOOD, F. R.S. &c. &c. Dedicated (by permission) to the Royal College of Physicians. 8vo. pp. 566. Cox and Co. 1817.

I

*

Na preliminary dissertation, we are informed that the plan of the work was laid down as early as the year 1803, thus exactly according with the precept of HoraceNonum prematur in annum; and, indeed, when we consider the length and labour of the work, we are almost inclined to wonder how a practitioner, engaged in professional duties, and other literary pursuits, could accomplish it so soon.

Having so often expressed our dissatisfaction at all the nosological attempts hitherto made, we had determined to impose a peculiar restraint on ourselves in the present instance, lest we should be warped either by prejudice or petulance. With this view we have paid the closest attention to the work; and shall, as often as possible, leave the author to speak for himself, and the reader to draw his own inferences.

"The main object (says Mr. Good in his preliminary Dissertation) of the present attempt is not so much to interfere with any existing system of NOSOLOGY as to fill up a niche that still seems unoccupied in the great gallery of physiological study. It is that, if it could be accomplished, of connecting the science of diseases more closely with the sister branches of natural knowledge; of giving it a more assimilated and family character; a more obvious and intelligible classification; an arrangement more simple in its principle, but more comprehensive in its compass; of correcting its nomenclature, where correction is called for, and can be accomplished without coercion; of following its distinctive terms as well upwards to their original sources, as downwards to their synonyms in the chief languages of the present day; and thus, not merely of producing manual for the student, or a text-book for the lecturer, but a book that may stand on the same shelf with, and form a sort of appendix

*In the Transactions of the Medical Society of London. See our Journal, vol, xxv. p. 56.

to,

to, our most popular systems of NATURAL HISTORY; and may at the same time be perused by the classical scholar without disgust at that barbarous jargon, with which the language of medicine is so perpetually tesselated; and which every one has complained of for ages, though no one has hitherto endeavoured to remedy it.

"The present, however, is but an attempt towards what is wanted, and is only offered in this view. How far such an attempt may be worth encouraging, and by what means it may be conducted towards a desirable degree of perfection, may perhaps be best determined by a brief glance at the chief nosological systems of the day, the nomenclature in actual use, and the general nature of the improvement proposed in the ensuing volume. It is the aim of this introduction to offer a few hints upon each of these subjects."

A section follows on "Nosological Systems." These, the author remarks, have been alphabetical, if such a modification is worthy of the name. "Another modification which has been had recourse to is that of the duration of diseases, as divided into chronic and acute. It is (continues Mr. G.) a modification of great antiquity, having descended to us from Aretæus and Cælius Aurelianus."

"A third modification has consisted in taking the anatomy of the animal frame as a ground-work for divisions; and consequently in assorting diseases, as has been done by Johnston, Sennert, and Morgagni, and since been recommended by Dr. Mead in his Medical Precepts and Cautions, into those of the head, chest, belly, limbs, and almost every other part. A fourth invention has fixed upon the supposed causes of diseases as a basis of distribution, and to this has been applied the epithet etiological, from the Greek terin iría, a cause; it has acquired more popularity than any of the preceding, and was especially embraced by the schools of Boerhaave, Riverius, and Hoffman. Sometimes a mixt modification has been attempted, as in the nosology of Dr. Macbride, who takes extent for his first two general divisions of diseases, as being universal or local, sex for his third, and the age of infancy for his fourth and last. And sometimes, and far more generally of late years, the nosological system has been built upon the DISTINCTIVE SYMPTOMS of diseases the peculiar marks by which they identify themselves, and, so to speak, become individualized and such is the principle adopted by Sauvages, Linnéus, Cullen, and all the most celebrated nosologists of recent times."

Having given this general historical view of nosology, Mr. Good enters into a more minute account of each writer. Plater he calls the morning star of symptomatology, as Serveto was of the circulation. Sydenham is said to have kept Plater always in view; and the attention of Sauvage to Sydenham first produced the attempt at reducing diseases to classes and orders. A general account of the methodical nosology follows, which is considered much too diffuse;

E e 2

but,

but, on account of its intrinsic merit, Mr. G. advises every one to read it. The success of Sauvage, or rather the admiration of his work, produced many imitators. These are enumerated, and afterwards the names of some authors, who, without pretending to give their works the character of nosologies, offered only an arrangement of one department, which they had pursued, or as making part of some Jarger work.

The next general nosologist in order is Linnæus, in whose system Mr. Good remarks the changes from Sauvage. Vogel's is next examined, as an attempt to supply the defects in Sauvage's system-Sagar, as in some measure re storing the same.

Upon the whole (says Mr. Good) it does not appear that the Nosologia Methodica of the Montpellier professor royal was much benefited, either in its arrangement or its substance, by any of these three attempts at improvement; while, in various respects, it was, perhaps, rendered less commodious and useful.

"VII. Such was unquestionably the opinion of Dr. Cullen, with respect to the two former of these--for that of Sagar was not then before the public-when he first thought of essaying his own powers in the field of symptomatic nosology; and hence, notwithstanding the later models that were before him, he resolved upon once more taking for a basis the original exemplar.

"The first objection, however, to this exemplar, which he seems to have felt, was not the mere series, but the nature of its classifi cation. The main object he proposed to himself, and a more important he could not lay down, was that of brevity and simplicity; and the Sauvagesian classification offended in both respects. He determined, therefore, upon charging it, and re-casting the system from its commencement. Instead of ten classes, he conceived that four alone might suffice, formed, as he proposed to form them, of a caliber capacious enough to swallow up all the rest. He moulded his four classes accordingly, and distinguished them by the names of I. PYREXIE, III. CACHEXIE,

and, influenced throughout the whole of his reform by the same spirit of simplicity and concentration, he reduced the forty-four orders of Sauvages to twenty, and his three hundred and fifteen genera to one hundred and fifty-one. He next carried his pruninghook into the field of species: some he found to be repetitions of the same disease occurring under different genera, and others mere symptoms of other disorders, instead of distinct or idiopathic affections; all which were steadily lopped off; and in this manner the reduction in the species bore an equal proportion to that in the genera. The genera and species that remained were next enlisted into his own service, mostly with the respective names assigned them by Sauvages, though the definitions were generally re-composed,

and apparently modelled in consonance with the reformer's own practical observations.

"Thus completed, and fit for use, the new system was first started in the largest medical school of Europe, its author presiding at the head of it. It is not, therefore, surprising that it should instantly have rushed into popularity, and become a subject of general approbation. Yet it did not stand in need of this adventitious support to introduce it to public favour. Its aim at simplicity, as well in extent as in arrangement, was noble, and bespoke correct views, and a comprehensive mind; it promised a desirable facility to the student, and a chaste finish to the architecture of the nosological temple. The author showed evidently that he had laboured his attempt in no ordinary degree; and many of his definitions discovered a mastery that had never before been exemplified-pictures painted to the life, and of proper dimensions.

"To this extent of praise Dr. Cullen's system is fairly entitled,— an extent which ought ever to be borne in mind amidst the numerous, and in many instances exaggerated, exposures of its defects which have lately been exhibited, and which it seems to be a growing fashion to detail both at home and abroad; more especially in Germany, where it has been asserted, ex cathedrá, and believed by extensive audiences, that, after all his pretensions, Cullen has done little or nothing for the improvement of nosology.

"That the system, nevertheless, has faults, and insurmountable ones, it would be absurd to deny; for they meet us at the very outset, and run through the whole of its texture and constitution. It is sufficient to notice the three following:-1. Defective arrangement. 2. Want of discrimination between genera and species. 3. Looseness of distinctive character in the last general division."

Several pages follow remarking the advantages and disadvantages of the Cullenian nosology, in which we could gladly have spared the allusions to the boundaries attempted by the late ruler of France, as well as a comparison of Cullen's locales to the cryptogamia of botanists; and still more his quotation from the Inferno of Dante, in illustration of diseases for which Cullen could find no place in either of his divisions. That we may not, however, do injustice to our author, we shall give the following specimen of his mode of enlivening a dull subject by an occasional sally of humour.

"Dr. Cullen, however, it must be admitted, has been as ingenious as he could; and contrived the means of giving, throughout all his classes, an entrance to diseases that have very little claim to admission. But the consequence is, that they make a sad medley, and, in inany cases, have not the slightest affinity or family resemblance; of which we have a striking example in psora and fractura, which follow in immediate succession in the class of local disorders. Psora (itch) can scarcely be called a local affection, unless the term be appropriated

appropriated to the skin generally, as distinguished from all the other parts of the frame; but, in this case, trichosis and lepra should have been placed in the same class, instead of in that of cachexies; while fractura could have no pretensions to such a class unless when compound. But it must certainly puzzle the best medical scholar in Europe, who is not acquainted with Dr. Cullen's arrangement, to discover the least connexion between itch and broken bones, and especially such a connexion as not only to draw them into the same class, but to make them immediate neighbours in the same order. Dr. Cullen, however, has ascertained that they are both local disorders, which entitles them to a common class, and both dialytic disorders, or produced by a division of continuity, which entitles them to a common order: and hence to the question, why is the itch like a broken bone?'-the student's answer is, because it is a dialysis: an answer somewhat wanting, perhaps, in professional gravity, but the only one that can be given. And here it is probable we must stop; for there seems no possibility of advancing farther, and assigning any reason for the very close intimacy allotted to psora and fractura by fixing them in immediate succession. Yet there is, perhaps, quite as much difficulty in determining what could be the author's motive for placing nostalgia in any part of the

same class.

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"2. It is impossible to take a survey, however brief, of Dr. Cullen's system, and not to notice his very extraordinary confusion of genera and species. And the author is the more induced to ad vert to it, because, extraordinary as such a confusion must appear to all who are acquainted with the difference, Dr. Cullen is by no means the only nosologist of our own day who has run into the same mistake, as will easily be perceived before the close of this dissertation."

Some very fair remarks follow on the impropriety of making single diseases so many genera. "A genus," says Mr. G. is a mere abstract term, a nonentity in nature, but highly useful,"-meaning, we presume, for artificial arrangement. Many other errors and inconsistencies are pointed out; and, even in the very best part of the Cullenian system, many inaccuracies are detected.

The writers on general or universal nosology being thus dismissed, a few remarks suffice for those who have made the attempt on a more confined scale. Selle's Methodical Pyretology is shewn to be very imperfect. Ploucquet's System, we are told, "is by far too complicated, and certainly not without its nebulosity,"-singularly distinguished by the author's fondness for long crabbed words. Pinel's Phi losophical Nosology is "too refined for popular use, and too indistinct for practical benefit," but his "arrangements of mental alienation" have been found very useful. To the other parts of his work many objections are added, which we conceive it unnecessary to notice.