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their ordinary state. Now, if the business of arrangement is to teach us how to act, the first question will be, whether we must commence our operations instantly, or whether we may be allowed time even to consult? And this makes the first grand division between acute and chronic diseases, in their attention to which, the ancients, without any nosological tables, so much exceeded the moderns.
“ The symptoms of a disease, (says Mr. Good,) indeed, have not unfrequently been said to constitute the disease itself. This is not perhaps strictly true; they are rather an algebraical character designating an unknown quantity, but which, in the bands of a skilful mathematician, may be managed as readily in working a propositioq as if such unknown quantity were a sensible object.
“ It is hence that the writings of Hippocrates and of Sydenham are so highly and deservedly esteemed; and will be so as long as niedicine shall be practised."
Some remarks follow on Celsus, whom we shall presently attend to, and we could wish Aretæus had been introduced also. Our first business, according to the instructions of these great men, and particularly the last named, is to disco. ver symptoms which immediately endanger the life of our patient, or the destruction of some important organ. When these are relieved, we are called on for diagnosis and prognosis, and for these we require a most exact description of those external appearances which mark the disease, and of the particular character in each which usually designate a favourable or fatal issue. Hence it follows, that, as in the same disease the symptoms are different in different stages, an arrangement to be useful must be modelled accordingly; nor can we illustrate this better than by Mr. Good's objec. tion to Darwin. If, when called to the bed-side of a person during the eruptive fever of small-pox, we discover synocha, are we to wait to see whether it will prove synochus, that is, typhus versus finem, or whether tertio die incipit eruptio, &c. Should the case prove highly inflammatory, would not our patient be irretrievably lost by such delay? If, on the other hand, the eruption has begun before we see our patient, are we not to direct our attention to the symptoms immediately before us, and is a disease with an eruption and one without au eruption to be discovered by the same characters? It may be urged, that it becomes us to make every enquiry. But this will lead us to etiology, the danger of attending to which in this state of things, we shall consider presently.
The great object then in acute diseases, is to enable ourselves to form a prompt decision, and it was not altogether erroneous that some of the ancients began their instructions
by an immediate application to signa et agenda. Celsus, who cannot be considered an original author, before he discriminates any diseases by name, marks certain symptoms or signs which require or authorize blood-letting, vomiting, purging, and other active remedies, which the urgency of the symptoms may imperiously demand, even though we are ignorant what the disease may ultimately prove. This then we consider the first and most important division of diseases, and so important, that in our opinion it should be unfettered with any distant considerations, which may paralyze our attempts at giving immediate relief, or preventing fatal consequences.
But, to come nearer to the point, typhus is called febris contagiosa. The cause, therefore, is contagion,
and unhappily this etiological distinction was thought a sufficient argument in favour of a practice which every family in the kingdom has, at different times, had cause to lament.
Let us recollect, that the ancients had none of the advantages we derive from the examination of those who have died of these fevers. Even Sydenham was deficient in this re. spect. But, by their mode of judging from the immediate symptoms, they acted with decision; and experience has shown, that, by such decision, they escaped those disasters which dissection has at last taught us are often the result of our nosological cautions.
Thus, whatever may be said of Darwin, to us, it appears, that, if the object of nosology is to direct us in diagnosis and practice, there is the utmost propriety in dividing small-pox into all the orders and genera which its appearance in its dif. ferent stages exhibits.
Respecting Dr. Parr, in our opinion, when coupled with Mr. Good, he has, to use the expression of the latter, given the death-warrant to all nosology. “ As a natural system, (says Mr. Good) even in botany, is, to the present hour, and perhaps always will be, a theoretical rather than a practical idea, there seems very little expectation that it can ever be realized in medicine.*** Now, without the necessity of a pun, the study of physic is the study of nature, and of all the branches of that study, medicine is the most important, and that which requires the most immediate reduction to practice; any thing, therefore, which takes off our attention from the immediate operations of nature is dangerous. If diseases were to be exhibited like fossils or plants, it would matter but little how artificial their arrangement might be.
* See above, page 216.
Chemical proportions, general configuration, or the form of certain parts at a certain period of existence or growth, may be sufficient for subjects on which we operate at our leisure, or which we turn to and produce as often as we wish to point out their distinguishing characters. Is such the object in designating acute diseases? At some very distant period, it may be accomplished in chronic cutaneous complaints, but, for this purpose, hospitals, sufficiently capacious, must be endowed, in wbich professors, sufficiently honest and enlightened, must preside.
This leads us to the consideration of those attempts of some authors to form a nosology of only certain
groups or families of diseases or monograms.".
Of these, Plenck, Willan, and Bateman, are principally noticed. The two latter have frequently come before us, we shall, therefore, only slightly mention the objections we find made to Willan, reserving our further remarks to the instances we shall produce from the system of nosology before us. Willan is said to be best suited for his restricted system, and that it would not well be interwoven into a larger plan.
“ As it is, indeed, it stands in need of no small degree of modification to clothe it with all the perfection it deserves; for several of his orders would make better genera; almost all bis
genera are decided species, while his species are seldom more than varieties, and are in many cases so denominated by himself.”
We confess ourselves not prepared to admire a part which will not adapt itself to a whole, nor a whole which will not harmonize with a well-constructed part.
At length we have arrived at Mr. Good's own plan, as stated in his preliminary dissertations. The general remarks on language have been already noticed. We now add, that it is with much pleasure we find no admission to pseudos and oideses, those disgraceful subterfuges of ignorance or indolence. We are aware such terms are to be met with in the methodical synopsis, or systems of other branches of natural history. But, besides what we have before remarked of the impropriety of attempting to confine nosology to the same artificial laws, we may add, that every science has divested itself of these terms in proportion as it has been more correctly taught. Ray, in his Synopsis Plantarum, omits four out of five pseudos, and Linnæus admits none. The latter is not less careful in discarding the oideses. Can there be a more wretched view of the most important science, than that, in the present day, it should avail itself of terms discarded by all the reformers in the other branches of natural philosophy.
After our decided approbation of Mr. Good's diligence, and, as far as our inquiries have extended, his accuracy in terminology, it is with no small concern, that, as soon as we enter on his arrangement, we meet with the words nosology and pathology used as synonymous. Pathology has always been applied to that knowledge by which, from the sufferings of the patient, we may detect the nature, if not the seat of his disease. Nosology is a modern science as well as a modern word, and, by the moderns, is applied to an artificial arrangement, by which we are to ascertain the order, class, genus, or species, of diseases.
We are absolutely frightened, when we re-peruse our own words, and still more so, when we recollect that we have been reading of " groups and even families of diseases," and that the arrangement or march of these is to vary according to the taste of every fresh nosologist. Can there be a stronger proof of the impracticability of accomplishing an object than that no two writers should agree, and that, in the midst of their atteinpts, they should lose sight of the only purpose to which every thing useful in the study of medi. cine is directed. Mr. Good informs us, that he has preferred according to the plan of modern physiologists, to take for his arrangement the animal frame in its more mature and perfect state, and trace it from some well defined and prominent function. He then speaks of links in a chain, and
urges the simplicity of his plan as according with all the systems of zoology, botany, and mineralogy, forming the arrangement, and selecting the characters from the most per. fect individuals as specimens. Is it possible, this learned and ingenious writer, after nine years' consideration, is not aware that this very sentence renders his whole labours useless or something worse. In every acute disease, are we to wait for the maturity and perfection of our specimen?Certainly not; but, it may be answered, by accurately ascertaining the true character from such a specimen in its most mature and perfect state, we ascertain the true disease, and, having once done so, it will not be difficult to mark the varieties. Can we wish, let us ask, for a more perfect specimen of small-pox and its varieties than Sydenham offers, or of the gout, or of fevers, than we meet with in the same writer ; or of the venereal disease, in all its forms, than Mr. Hunter presents us; or of scarlatina, than Fothergill's ; of elephantiasis, than Dr. Adams's; or of bronchitis, than Badman's? And what assistance have they derived from artificial arrangement? But, it will be said, if we wish to avail ourselves of the labours of others, or