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ticism, under the impression that the more we advance in the knowledge of animate nature, the more are we surrounded with clouds and darkness, which science attempts in vain to penetrate and disperse. Such feelings, however, and such conduct, would rather seem to imply an imbecility of mind, than a superiority of understanding. Nothing is more easy than to be sceptical; and nothing, in some cases, is more reprehensible. Certain it is, that the nature of medical evidence is not precisely similar to that which is the result of physical investigation, and that it even differs from those truths which attach themselves to ethical and moral researches : but that there are truths in medicine, that there is a satisfaction to be obtained by cultivating the science,~can only be denied by such individuals as are glad of pretexts and apologies for the indulgence of an indolent disposition. If medical science were certain, say some, the art of healing diseases would be more progressive, and malignant maladies would cease to triumph over professed remedial
provements. But this allegation goes upon the forgetfulness of two particulars, which ought, in all fairness, to be taken into account before any comparison can, with propriety, be instituted between ancient and modern medicine. In the first place, then, as in the progress of the arts, and the cousequent increase of refinement, man becomes more artificial, and less independent on external circumstances; he naturally and necessarily becomes in the same ratio more obnoxious to the influence of powers that are adverse to his state of physical well-being; for it is a law of nature, that we cannot enjoy without suffering. Open the springs and sources of pleasurable feeling, and causes creative of painful sensation immediately rush up in a proportionate measure. Multiply and nagnify your remedial influences, and you thereby increase the necessity for their agency. An advocatė, then, for the principle, that the art of healing is actually in a state of progressive improvement, has only to establish the fact, that the diminution of physical evil at all corresponds with the increased measure in which it is engendered, and he at once fairly discharges himself from the onus probandi.
But, further, the different relative connexion of practitioner and patient, now and formerly, ought to be considered, when these comparisons are suggested between the state of disease and medicine in former periods, and that of the present day. Before the time that the vernacular language constituted a vehicle of medical disquisition, the disputes of the schools were confined to the schools; and the sick, supposing all was going on straightforward and right, placed implicit confidence in the judgment of the physician, and in the power of medicine: but now, that all is thrown open to public
gaze, and every reader, even of a magazine, has opportunities of witnessing the clashing of accredited authorities, respecting subjects which actually involve the issues of life and death, we cannot wonder at the comparative scepticism which prevails on the extent of medicinal infallibility. Crowds of devotees no longer throng the temples of Esculapius, and return with their faith confirmed, and their diseases healed. Men, in our days, require to be told the ground of the hope that is in us; and thus, as science advances faith recedes, and the operation of medicine is more and more reduced to its abstract, actual, physical effect. But as we find men, so must we treat them-as we meet with the art, so must we practise it: and the comparative difficulty and complication of our present professional undertakings ought to excite industry, rather than repress exertion. Let us, then, my fellow-laborers in the same vineyard, not be scared from our duty by the ridicule of the faithless, or be induced to bury our talents in the anticipation of a hard account, but continue to work, in despite of difficulties, with the laudable hope of eventual reward.
Were it nothing but the satisfaction which the mind feels in the progressive development of physical truth, even admitting that we cannot always turn such truth in medicine to a practical account, the research itself would bring with it its own recompense. Could it, for example, be established, as some have falsely endeavoured to prove, that all the control the practitioner possesses over sabulous and calculary complaints, is confined to the regulation of the digestive states ; and that, therefore, practically considered, a knowledge of the different nature of these concretions is nugatory: even in that case, the man who should have made himself master of the respective varieties of these concretions, would, certainly, at any rate, not prove a worse physician than his more easily satisfied contemporary, who should aim at justifying his ignorance by advancing the cui bono interrogation, or pleading the inutility of the knowledge in question.
It may appear, Gentlemen, a work of supererogation, to argue before such an assembly as I have now the honor of addressing, either for the certainty, importance, and improvement in medical science, or the responsibility of the practitioner to cultivate medical philosophy, rather than to launch out upon the shoreless sea of empirical adventure: but, if I may presume to make my own consciousness at all the measure of others' minds, we collectively and individually stand in constant need of repeated calls upon our every exertion : and one motive, I conceive, for the appointment of these annual opportunities, is for the purpose of that mutual excitement which the esprit de corps calls forth into effect. Of this respectable
and learned body it is needless to say, that I am but an humble and distant member; but I would do my best to act consentaneously with all its other larger and more important members, for the purpose of preserving the whole in exercise and health.
But, not to occupy any more of your time in introductory matter, I shall now immediately proceed to the particular business of the present address, namely, to express my unbiassed sentiments on the state both of speculative and practical medicine ; for certain it is, that even in this our day, we have actual, if not avowed schools of medical theory, and of theory which is still, perhaps, more influential upon practice than those which were formerly broached in the manner of systematic doctrines.
There is nothing, perhaps, more characteristic of man than a restless desire to pry into causation, which induces an ansiolis wish to connect, as it were, by one bond of union, the various phenomena that present themselves to his observation : or, as it may be expressed in other words, to deduce general principles from particular facts. This analogical deduction constitutes, indeed, the chief business of philosophy, which is very little more than a proper classification and register of facts and appearances : but the mischief is, and always has been, that we are apt to suppose analogy which does not actually exist. The phenomena about which our observation is engaged, “ are received in the light in which we wish them to appear, rather than in that in which Nature presents them," and thus we substitute conception for perception; and, as a consequence, hypothesis for truth. Before, indeed, the Baconian philosophy had actually marked out the distinctive line between conjecture and inference, man was led by his love of causation to substitute mere abstractions of his fancy for physical realities, and thus thought himself advancing in the path of science, while he was in pursuit of a mere phantom of his own imagination : hence “ the iteration without improvement,” which Lord Bacon observed and complaiued of in the science of medicine ; a change of terms without a change of things. These shadowy essences do not so easily satisfy the minds of inquirers, in the present day, as they did in former times : we still, however, tend too much to illegitimate generalisation of another kind; which, in contradistinction to the metaphysical generalities of the ancients, may properly enough be called physical errors. Thus the disputes now run upon the actual changes which the bodily organisation undergoes in order to constitute disease; and, guided by the desire just alluded to, as ingrafted in man's nature to refer every thing to one ruling principle, pathologists of the present day look into one particular organ, or part of the body, as the grand medium for the elaboration
both of healthy and deranged action. Thus the head, the stomach, the liver, the blood-vessels, are each put in successive requisition for the purpose of solving the enigma of disease ; all views looking more or less to one, to the exclusion of other principles.
I would class the prevailing theories of the present period under those in the first instance, which attribute every thing to the liver. I would, secondly, observe upon those pathological views of disease, which can discern nothing but through the medium of the digestive organs: and, lastly, I would refer to those principles which seem to exalt the incidental circumstance of vascular irritation too much into the rank of cause, and which, at times, predicate the existence of such irritation, when it is not actually present.
In respect to that theory which regards the liver as the primum mobile of every thing of a morbid nature, and the consequent practice founded upon these hepatic views, I have often thought, that when the mania has fully subsided, our successors will find it difficult to reconcile our boasted freedom from the influence of prevailing doctrines, with our passive and practical acquiescence in that system which hepatism has pronounced to be good, and has commanded the medical world to bow to and obey. Turn the great lobe of the liver, say the champions of the sect now adverted to, and you will find diseases lying as thick as ants in a mole-hill
, which has been disturbed by the scythe of the mower. This is the real Pandora's box, the origo et causa morborum omnium; the something which, if you can regulate, you can control disease; if not, disease will bid defiance to all your remedial endeavours. Do you see a child dying with hydrocephalus; what can possibly have produced the derangement, and the approaching death, but something wrong in the liver ? Is the disorder tic doloureux, or headach or apoplexy, or epilepsy, or madness, or blindness ; see to it that the liver is in a proper state before you
either think of cause, or dream of cure. To what other sources than obstructions in the liver can we attribute those affections which have been referred, but erroneously, to primary disorder in the chest? Does the blood find a difficult transmission through the lungs; such difficulty must have been first experienced by the liver. Are there tubercles, or ulcerations, or asthmatic conditions observable in these organs ; how can such tubercle, or ulcer, or asthmatic affection, have originated without the liver having planted their seeds, and regulated their growth? Do we find inflammatory conditions, aneurismal dilatations, organic obstructions in the heart and its great blood vessels; who shall pretend that ossification, that obstruction, that dilatation, can have place, unless through the agency of the liver? Stomach and bowel derangements, would our
theorists say, are still more obviously and unequivocally our own. Concede this to us, and at the same time observe bow intimately connected such ventricular states are with the origin and decline of many other morbid affections, and the inference must be, that all these maladies are, in reality and effect, hepatic. Rheumatic inflammation, for instance may, or may not, be an inflammation seated in membraneous fascia : but whether it be, or be not, it is the liver which has transmitted the blood, charged with powers to create the local disturbance. Again, an individual is attacked with what you please to name gout. How frequent it is to observe such attack alternating with states in which the liver is undeniably affected in its functions : ergo, do our hepatic logicians infer, gout is resident in the liver? Multiform and various, to be sure, are the disordered irritations to which the kidneys and connected parts are obnoxious. The urine, instead of being poured out from its gland of secretion, with all its healthy products and principles, is sometimes found loaded with a vast proportion of saccharine matter: but it is needless to amuse yourself with fine spun theories of the quo-modo of such phenomenon: it is further loss of time to aim at ascertaining the different qualities and ingredients of calculary formation, or try to find out the modus operandi of lithic concretion ;-it is all, all done by the liver; and looking at any thing less than the liver, we merely investigate incidental effects, instead of being more sensibly and more profitably engaged in raising our contemplation to the source of every thing.
Have I, Gentlemen, drawn a caricature portrait of this great liver leviathan ? Certain it is, that I have not so far disfigured the likeness in the delineation, but that the portrait must be universally recognised; and I shall now draw a little more upon your indulgence, by saying a few words respecting the origin and prevalence of this hepatic hyyothesis.
At the time when the Edinburgh school of medicine became of paramount authority through the whole of Britain, Dr. Cullen was appointed to the principal medical professorship in that university, and in the system of medicine which he published, proclaimed his partiality to the Hoffmanic doctrine of fibrous debility as explicatory of disordered states : instead, therefore, of vitiated fluids and corrupt humors, formerly the cant of the day, all becanie now atony and spasm, and tonics, and corroberants. The great rival of Cullen, Dr. John Brown, did very little more than confirm these fibrous notions, although he so very materially altered the language in which they were conveyed; and aimed at simplifying the sources from which the debility proceeded, and the consequent indications of treatment. Eight-tenths of all the maladies incident to man