LECTURES ON THE THEORY AND PRACTICE OF PHYSIC,

LECTURES ON THE

THEORY AND PRACTICE OF

PHYSIC,

BY DR. CLUTTERBUCK.

Theatre,

General Dispensary, street.

,

engage the

OF all the studies that can attention of man, that of medicine is nnquestionably the most important. Taken in its greatest latitude, the science of medicine is of vast extent, and involves in it so many distinct branches of investigation, that the whole life of man may be occupied in its study without his becom. ing thoroughly acquainted with it. In commencing it, therefore, we should proceed slowly and methodically, making one step sure, before we attempt another. In the former lecture, I defined medicine as " the art of treating (not of curing) diseases." But the nature of disease itself mnst be understood, before it can be treated satisfactorily and with the greatest success. Like every other art, medicine is governed by certain general principles, which constitute its theory, and these require to be understood before we can practise the art with success. This is true even of the most simple art ; for instance, agriculture, which is always practised with greater success when its principles are understood. In medicine, these principles constitute the science, as i the practical part does the art. It is hardly necessary to mention, that the seat of disease is the human body, which, for the purpose of illustration, may he not unaptly coiiipared to a delicate and complicated piece of rnachinery ; .so delicate and complex, indeed, that it is wonderful it should ever perform correctly. Now the regular performance of this machine, in all i-ts parts, constitutes

[No.

114

first falls into disorder; this affects others with it, by what we call symat length, in many cases, the whole becomes deranged. "‘his’ disease is either partial or general, and when general, is nevertheless almost always partial at its outset or commencement. Disease is nothing essentially different from health. It is nothing mysterious; nothing which the mind" does not comprehend ; it is not the workings of an evil spirit." Disease is merely a deviation from the healthy state. The same parts are concerned in disease as in health ; and the same functions of circulation, absorption, secretion, &c. carried on, only in an irregular or perverted way. Disease, in fact, is only to be.known or understood by comparing it with the healthy state, which, therefore, must be first studied. The study of the body in health, is this is the only basis termed upon which medical science can be built. Now, for the same reason that, in order to understand the nature and movements of any piece of mechanism, a clironometer, for instance, we should take it to pieces, and examine the parts in detail; so it is with the animated machine—the human body, entrusted to our care. The construction of this also must be investigated as far as possible, its hidden parts brought to light, and its texture unravelled. This requires manual examination, and the art which enables us to do this is termed anatomy, or dissection, which is as necessary to physiology a3 the latter is to medical science. Anatomy, therefore, is naturally the first step to be taken in the study of medicine, if we would pursue it in a methodical or scientific way. But anatomy, is still mote in-

Aldersgate- connected pathy, till

LECTURE II.

Gentlemen,

the state of perfect health, while the imperfect or irregular performance of it is disease. The comparison, indeed, may be carried fiirther. It is commonly one part only of a complicated machine that is first out of order; but this may subsequently derange and disturb the movements of the whole. So it is with the body in dis. ease. One part, or organ, as we term it,

’

physiology;

[Nov. 5, 1825.]

210 the manual branch of meis only recognised by its effects. what we term surgery. The But although anatomy is thus imperfect, surgeon cannot proceed a step safely in and does not make us acquainted with his operations without it,. but is in coq- the ultimate structure of the body, yet it his patient, is at great service to us, as leading to a stant danger of that are essential to life, knowledge of its functions., Physiology, injuring parts such as the great blood vessels and or the knowledge of the functions in nerves. lf anatomy be necessary to the health, is an indispensable preliminary to physician, it is doubly so to the surgeon, pathology, or the explanation of diseases. and therefore I would impress upon your It points out to us what life and health minds, Gentlemen, the great importance are; and it is only by comparing the of your attending to this branch of study signs of disease with those of health, that during your stay in the metropolis, and,we are enabled to judge how, or in what the more so, as it can hardly be success- degree, the body is at any time diseased. fully prosecuted, except in large cities. Physiology is the mirror from which pa. Thus far, the analogy between the 1m-I thology, or the knowledge of disease, is man body and an inanimate machine,reflected ; accordingly, before I enter on -holds good; but there are great diffe- the consideration of the morbid state of rences observable between the humanthe system, or any of its parts, I shall machine and one framed by the art ofmake a pointof premising a general acman. The latter we can take to pieces,count of the animal economy, and of its observe the several parts, and put themvarious functions. The human body, like other living together again. If any part should be injured, we can repair it, and can even beings, is endowed with peculiar properreplace any part that may be necessary. ties and powers, which serve to distinThis cannot’be done with living matter; guish it from inanimate matter. These on account of the extreme minuteness ofproperties and powers it derives frolll . the parts, we cannot even acquire a know- the principle of life ; they are therefore of the ultimate structure of .called the vital properties. Some ot these . beings. Our senses, even with artificial aid,.! it possesses in common with all living are incompetent to detect the ultimate ; things, plants as well as animals; others texture of the body. At first view, it ap- I, belong only to animals, and are deniett to vegetable beings. Thus, vital proper-pears to be made up of but a few parts-as blood vessels, nerves, and ab- ties are either general or speciccl. The sorbents, variously combined, and unitedI former I shall now proceed briefly to contogether by intervening cellular sub-sider; the latter, I shall reserve till we stance, so as to form the different organs.. come to treat of the human body more But look further, and we find that these particularly, in which those special vital parts, simple as they at first appeared,, properties are the most distinctly marked. are themselves compounded; each artery The properties then which characterise having its blood vessels, (vasa vasorum,)life in general appear to be the follownerves, and absorbents, for the purposes in!!::of its own growtti and actions. Nerves 1.—A peculiar chemical composition. again, though they appear to be simple 2.-A certain texture, or arrangement cords, are found to consist of parallel of parts, which is called structure, or orbundles of smaller nerves, each of which ganization. 3.—A power of self-preservation, or may be subdivided. Nerves have also blood vessels ramifying over their coats, resistance to external agents. and penetrating their substance, which 4.-A susceptibility of impression, or a erve for their support and nourishment, capability of being ikifluenced by external and in all probability contribute not canses. a little to their energy. All this is ob.5.-Mobility, or a power of spontaneous vious with regard to the larger blood ves- motion, commonly called action. sels and nerves, and, from analogy, we 6.-A power of gyowth, or enlargeinfer the same of the most minute ; nor ment ; and, lastly, So that can we assign any limits to this. 7.-A power of reproduction, by which, anatomy carries us but a little way into though the individual perishes,the species the recesses of the animal economy. is preserved and perpetuated. These properties belong equally to Another difference between the human machine and those constructed by man plants as to animals. They have been is, that we are totally unacquainted with lately termed organic functions, or the the principle, or mainspring, which puts functions of organic life ; which designait in action; I allude here, of course, to tion, however, appears objectionable, as the vital principle, with the nature of’ implying that they are the result ofstrucwhich we are totally unacquainted, and ture, or organization, merely. They might

dispensable to dicine,

I which

or

destroying

’ledge

by

living

simple

-

211 be more

ealted general vital pro- main, to all properly after life has those are confined to

appearance,

perfect, long

that aniceased ; as is observed in mals may be denominated special.. I shallI various plants and animals., which, when now proceed to speak of them somewhat placed in certain circumstances, continue unattered in structure for months and more in detail years, though deprived of life. We have no reason to say, therefore, that life conI.-Of the Chemical Composition of living sists in organization, but in a principle in general. Being-s superadded to this. Again, we find that The chemical composition of living living beings are deprived of life by means beings is very different from that of com- which do not apparently affect the strucmon, or inanimate matter of any kind; ture ; and from this we miglit inter, that the elements, however, are the same ; structure is not the cause of life. Strucoxygen, hydrogen, and carbon, with, in ture may exist without life ; but’life puts some cases, azote and phosphorus, con- the structure into action. stitute all that is essential to the compoLite, however, is never manifested, but sition of living beings ; but each of these in connexion with a certain structure; elements exists abundantly etsewherf. and it disappears whenever the structure The difference between living and com- is entirely destroyed ; hence there apmon matter consists, merely, in the num- pears a necessary connexion and depenber of the elements present, their propor- dance between them. This is further tions and manner of combination. As long probable trom the fact, that the vital as life lasts the composition is preserved, properties are always observed to be but when life ceases the tie that unites modified and determined by the structure. them in sueh modes of combination is Thus, every different organ, while it is dissolved. Sooner or later, according to peculiarly constructed, has its peculiar circumstances, the elements again sepa- mode both of feeling and acting. The rate, and assume the form of common liver, for example, does not secrete matter. Such as are volatile escape, urine ; nor the kidneys, bile ; because the singly or combined, into the surrounding necessary structure is wanting. The atmosphere; the fixed remain behind, and eye is not sensible to the same impresconstitute but a small part of the general sions as the ear, and for a similar reason. mass ; a little earth, and a very small Even in diseases, when the structure of portion of saline matter only, being found a part is altered, the vital phenomena are after the entire decay of an animal different. For example, if the liver be vegetable body. the action of the organ undergoes a change, and the bile that is formed 2.—Of the Structure, or Organization of is not healthy. These facts, it must be living Beings. allowed, prove that structure has a very The second property that serves to important influence upon life. They do distinguish living from common matter, not, however, go so far as to show, that is a peculiar textnre or arrangement of structure is the cause of life, but merely parts, which is termed structure, or orga- that there is a connexion between them. tzzzation. This is in general sufficiently obvious on inspection, yet not easy to be 3.—Of the P2-esen)ative P-operty of Life. denned. It may be said, however, to be fibrous and often tubular, with cellular The property of self-preservation is interstices ; the tubes, or vessels, as they another of the characteristic properties are called, containing a variety of fluids, of life, and shows itself by a resistance to which are kept in motion, often in a cir- the influence of various external agent.3,; cte, chiefly by the contractions of the as heat and cold, fermentation,-putrefacvessels in which they are lodged. In va. tion, &c. which act readily upon dead rious living beings, however, and in the matter. A living being preserves its judimeats of all, no distinct arrangement temperature, to a great degree, under of parts is discoverable by the eye, though opposing circumstances. Animals do not this is by no means a proof of a want of readily acquire the temperature of a heated organization, but rather of our limited atmosphere, nor of a cold one ; but prefaculty of observation. The changes serve, in such circumstances, that degree which they undergo (the egg, for heat which is natural to them. Thus do not allow the supposition that the human body is very nearly of the are homogeneous. We may, with reason, same degree of heat in winter as in sumascribe our not being able to distinguish mer,-in hot as in cold climates. An egg their structure to the extreme subtility resists freezing for a long while, though pf the fibres. placed in the coldest medium: that is, as The structure or organization may re- long as its living principle remains. Deprive

pwtie’s,

as

ordiseased,

instance)of they

212

In

it of this by an electric shock, or by destroying its texture by mechanical violence

addressing

you

as

friends and

show you the confi. or by agitation, or by previously subject- dence I place in your zeal for profe‘sional ing it to any extreme of temperature, it knowledge, by my consciousness of how no longer resists the application of heat or much I must trust to your indulgence in cold, but obeys the common laws of in. whatever relates to the manner of comanimate matter. Saccharine matters, municating that information which I hope which in common circumstances readily to render useful to you. Actively engaged undergo fermentation, suffer no such from early life in the duties of the prochange in the stomach of living animals fession to which I am devoted, my leisure while they are in health. Putrefaction of moments have been chiefly directed to animal substances also ceases to go on, in obviate the recurrence of those anxieties, the same situation. A living egg remains which every surgeon must occasioually in the midet of a mass of putrefying ani- experience, by the careful observation of mal and vegetable matters ; but deprive disease and its consequences; by some it of life, by any of the above mentioned reading, and not a little reflection. Thus means, and it immediately hastens to circumstanced, the occasions for deliverdecomposition and decay. It is thus, also,ing my sentiments in public have been that our bodies often resist various I few, and my inclination to make use of causes of disease-as contagion, and heat them still less frequent. A living author, whose perseverance and cold, without being disordered by them. This power of resistance, how. and successful exertion to extend th6 ever, has its limits ; and is not sufficientscience, and improve the practice of surat all times to guard us against the ap- gery, entitle him to the gratitude of the has observed : proach of* disease. " If we go into a court of law, we see When, by disease, the vital powers beeome greatly reduced, either in the whole the bench occupied by the learned judges; body or in particular parts, the body be- before them are counsel skilled in the comes in consequence less able to resist law, and a jury of twelve honest men, to the influence of other agents. Thus it is, hold the balance betwixt the severity of that vegetable matters undergo fermen- the law and the weakness of human natation in weak stomachs ; and, in this ture. What are they met to decide? way, acidity of stomach is produced. Perhaps a matter of money or of stiecesThus also, the body, when weak, is more sion. Even if it should be a criminal court, susceptible of the influence of miasmata what a contrast have we with the situand contagion ; that is, its powers of re- ation of the snrgeon, on whose single sistance are diminished, by the diminution decision the life of a fellow-creature deof vital power. pends, one, perhaps, bearing all the At my next lectnre, gentlemen, I shall relationships of society; having all the speak of the other characteristic proper- ties which bind a man to existence, and the virtues which make his life dear. The ties of life. surgeon cannot lean upon the judgment of others, nor say, for this the wisdom of the legislature has provided. He has to examine an evidence often strangely perverted ; he must judge, unaided by

fellow-students, I

community,

LECTURES

friendly counsel ; and,

to

determine upon

right to be done, when the life of friend hangs on the issue, and where

what is ON SOME

a

PRACTICAL POINTS OF SURGERY, the execution depends on his own-dexterity, is a thing of the greatest difficulty.’ DELIVERED TO THE

Students of the late Borough Dispensary, BY MR. ALCOCK.

LECTURE II.

Arduous as the performance of operations may be, the judgment required to decide on the propriety of operations is equally important; since however skilful an operator may be, if an operation be performed without necessity, it is a dread.

ful infliction:—if

neglected

when

neces-

sary, the patient’s life may pay the forGentlemen, feit. That the medical profession must At onr last meeting I made some obser- be a blessing or a curse, according to the vations on the more common defects inendowments or ignorance of those who medical education : the subject of the undertake its duties, must be,sufficiently present lecture, is the Investigation ofobvious. In pointing out some of the prominent disease,