[No. 114 [Nov. 5, 1825.]

LECTURESON THE

THEORY AND PRACTICE OF PHYSIC,

BY DR. CLUTTERBUCK.

Theatre, General Dispensary, Aldersgate-street.

LECTURE II.

Gentlemen, ,

OF all the studies that can engage theattention of man, that of medicine is nn-questionably the most important. Takenin its greatest latitude, the science ofmedicine is of vast extent, and involvesin it so many distinct branches of investi-gation, that the whole life of man may beoccupied in its study without his becom.ing thoroughly acquainted with it. In

commencing it, therefore, we should pro-ceed slowly and methodically, making onestep sure, before we attempt another.In the former lecture, I defined medicineas " the art of treating (not of curing)diseases." But the nature of diseaseitself mnst be understood, before it canbe treated satisfactorily and with thegreatest success. Like every other art,medicine is governed by certain generalprinciples, which constitute its theory,and these require to be understood be-fore we can practise the art with success.This is true even of the most simple art ;for instance, agriculture, which is alwayspractised with greater success when itsprinciples are understood. In medicine,these principles constitute the science, as ithe practical part does the art.It is hardly necessary to mention, thatthe seat of disease is the human body,which, for the purpose of illustration,may he not unaptly coiiipared to a deli-cate and complicated piece of rnachinery ;.so delicate and complex, indeed, that itis wonderful it should ever perform cor-rectly. Now the regular performance ofthis machine, in all i-ts parts, constitutes

the state of perfect health, while the im-perfect or irregular performance of it isdisease. The comparison, indeed, may becarried fiirther. It is commonly one partonly of a complicated machine that is firstout of order; but this may subsequentlyderange and disturb the movements ofthe whole. So it is with the body in dis.ease. One part, or organ, as we term it,first falls into disorder; this affects othersconnected with it, by what we call sym-pathy, till at length, in many cases, thewhole becomes deranged. "‘his’ diseaseis either partial or general, and when ge-neral, is nevertheless almost always par-tial at its outset or commencement.

Disease is nothing essentially differentfrom health. It is nothing mysterious ;nothing which the mind does not com-prehend ; it is not the " workings of anevil spirit." Disease is merely a devia-tion from the healthy state. The same

parts are concerned in disease as inhealth ; and the same functions of circu-lation, absorption, secretion, &c. carried

on, only in an irregular or pervertedway. Disease, in fact, is only to be.knownor understood by comparing it with thehealthy state, which, therefore, must befirst studied. ’

The study of the body in health, istermed physiology; this is the only basisupon which medical science can be built.Now, for the same reason that, in orderto understand the nature and movementsof any piece of mechanism, a clironome-ter, for instance, we should take it to

pieces, and examine the parts in detail;so it is with the animated machine—thehuman body, entrusted to our care. Theconstruction of this also must be investi-gated as far as possible, its hidden partsbrought to light, and its texture unra-velled. This requires manual examina-tion, and the art which enables us to dothis 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 betaken in the study of medicine, if wewould pursue it in a methodical or scien-tific way. But anatomy, is still mote in-

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dispensable to the manual branch of me-dicine, or what we term surgery. The Isurgeon cannot proceed a step safely inhis operations without it,. but is in coq-stant danger of destroying his patient, byinjuring parts that are essential to life,such as the great blood vessels andnerves. lf anatomy be necessary to thephysician, it is doubly so to the surgeon,and therefore I would impress upon yourminds, Gentlemen, the great importanceof your attending to this branch of studyduring your stay in the metropolis, and,the more so, as it can hardly be success-fully prosecuted, except in large cities.

Thus far, the analogy between the 1m-Iman body and an inanimate machine,-holds good; but there are great diffe-rences observable between the humanmachine and one framed by the art ofman. The latter we can take to pieces,observe the several parts, and put themtogether again. If any part should beinjured, we can repair it, and can evenreplace any part that may be necessary.This cannot’be done with living matter;on account of the extreme minuteness ofthe parts, we cannot even acquire a know-’ledge of the ultimate structure of living. beings. Our senses, even with artificial aid,are incompetent to detect the ultimatetexture of the body. At first view, it ap- I,-pears to be made up of but a few simpleparts-as blood vessels, nerves, and ab-sorbents, variously combined, and unitedtogether by intervening cellular sub-stance, so as to form the different organs.But look further, and we find that theseparts, simple as they at first appeared,are themselves compounded; each arteryhaving its blood vessels, (vasa vasorum,)nerves, and absorbents, for the purposesof its own growtti and actions. Nervesagain, though they appear to be simplecords, are found to consist of parallelbundles of smaller nerves, each of whichmay be subdivided. Nerves have alsoblood vessels ramifying over their coats,and penetrating their substance, whicherve for their support and nourishment,and in all probability contribute nota little to their energy. All this is ob-vious with regard to the larger blood ves-sels and nerves, and, from analogy, weinfer the same of the most minute ; norcan we assign any limits to this. So that

anatomy carries us but a little way intothe recesses of the animal economy.Another difference between the human

machine and those constructed by manis, that we are totally unacquainted withthe principle, or mainspring, which putsit in action; I allude here, of course, tothe vital principle, with the nature ofwhich we are totally unacquainted, and

which is only recognised by its effects.

But although anatomy is thus imperfect,and does not make us acquainted withthe ultimate structure of the body, yet itis at great service to us, as leading to aknowledge of its functions., Physiology,or the knowledge of the functions in

health, is an indispensable preliminary topathology, or the explanation of diseases.It points out to us what life and healthare; and it is only by comparing the

signs of disease with those of health, thatwe are enabled to judge how, or in whatdegree, the body is at any time diseased.

Physiology is the mirror from which pa.thology, or the knowledge of disease, is

reflected ; accordingly, before I enter onthe consideration of the morbid state of

the system, or any of its parts, I shallmake a point of premising a general ac-count of the animal economy, and of itsvarious functions.

The human body, like other livingbeings, is endowed with peculiar proper-ties and powers, which serve to distin-guish it from inanimate matter. These

properties and powers it derives frolll .the principle of life ; they are therefore

.called the vital properties. Some ot these.! it possesses in common with all living; things, plants as well as animals; othersbelong only to animals, and are deniettto vegetable beings. Thus, vital proper-ties are either general or speciccl. The

I former I shall now proceed briefly to con-sider; the latter, I shall reserve till we. come to treat of the human body more

particularly, in which those special vital, properties are the most distinctly marked.

The properties then which characteriselife in general appear to be the follow-

in!!::- -

1.—A peculiar chemical composition.2.-A certain texture, or arrangement

of parts, which is called structure, or or-ganization.

3.—A power of self-preservation, orresistance to external agents.4.-A susceptibility of impression, or a

capability of being ikifluenced by externalcanses.

.5.-Mobility, or a power of spontaneousmotion, commonly called action.6.-A power of gyowth, or enlarge-

ment ; and, lastly,7.-A power of reproduction, by which,

though the individual perishes,the speciesis preserved and perpetuated.

These properties belong equally toplants as to animals. They have beenlately termed organic functions, or thefunctions of organic life ; which designa-tion, however, appears objectionable, as

’ implying that they are the result ofstruc-ture, or organization, merely. They might

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be more properly ealted general vital pro-pwtie’s, as those that are confined to ani-mals may be denominated special.. I shallnow proceed to speak of them somewhatmore in detail

I.-Of the Chemical Composition of livingBeing-s in general.

The chemical composition of livingbeings is very different from that of com-mon, or inanimate matter of any kind;the elements, however, are the same ;oxygen, hydrogen, and carbon, with, insome cases, azote and phosphorus, con-stitute all that is essential to the compo-sition of living beings ; but each of theseelements exists abundantly etsewherf.The difference between living and com-mon matter consists, merely, in the num-ber of the elements present, their propor-tions and manner of combination. As longas life lasts the composition is preserved,but when life ceases the tie that unitesthem in sueh modes of combination isdissolved. Sooner or later, according tocircumstances, the elements again sepa-rate, and assume the form of commonmatter. Such as are volatile escape,singly or combined, into the surroundingatmosphere; the fixed remain behind, andconstitute but a small part of the generalmass ; a little earth, and a very smallportion of saline matter only, being foundafter the entire decay of an animal orvegetable body.

2.—Of the Structure, or Organization ofliving Beings.

The second property that serves to

distinguish living from common matter,is a peculiar textnre or arrangement ofparts, which is termed structure, or orga-tzzzation. This is in general sufficientlyobvious on inspection, yet not easy to bedenned. It may be said, however, to befibrous and often tubular, with cellularinterstices ; the tubes, or vessels, as theyare called, containing a variety of fluids,which are kept in motion, often in a cir-cte, chiefly by the contractions of thevessels in which they are lodged. In va.rious living beings, however, and in thejudimeats of all, no distinct arrangementof parts is discoverable by the eye, thoughthis is by no means a proof of a want oforganization, but rather of our limitedfaculty of observation. The changeswhich they undergo (the egg, for instance)do not allow the supposition that theyare homogeneous. We may, with reason,ascribe our not being able to distinguishtheir structure to the extreme subtilitypf the fibres.The structure or organization may re-

main, to all appearance, perfect, longafter life has ceased ; as is observed in

I various plants and animals., which, whenplaced in certain circumstances, continueunattered in structure for months andyears, though deprived of life. We haveno reason to say, therefore, that life con-sists in organization, but in a principlesuperadded to this. Again, we find thatliving beings are deprived of life by meanswhich do not apparently affect the struc-ture ; and from this we miglit inter, thatstructure is not the cause of life. Struc-ture may exist without life ; but’life putsthe structure into action.

Lite, however, is never manifested, butin connexion with a certain structure;and it disappears whenever the structureis entirely destroyed ; hence there ap-pears a necessary connexion and depen-dance between them. This is furtherprobable trom the fact, that the vitalproperties are always observed to bemodified and determined by the structure.Thus, every different organ, while it ispeculiarly constructed, has its peculiarmode both of feeling and acting. Theliver, for example, does not secrete

urine ; nor the kidneys, bile ; because thenecessary structure is wanting. Theeye is not sensible to the same impres-sions as the ear, and for a similar reason.Even in diseases, when the structure ofa part is altered, the vital phenomena are

different. For example, if the liver bediseased, the action of the organ under-goes a change, and the bile that is formedis not healthy. These facts, it must beallowed, prove that structure has a veryimportant influence upon life. They donot, however, go so far as to show, thatstructure is the cause of life, but merelythat there is a connexion between them.

3.—Of the P2-esen)ative P-operty of Life.The property of self-preservation is

another of the characteristic propertiesof life, and shows itself by a resistance tothe influence of various external agent.3,;as heat and cold, fermentation,-putrefac-tion, &c. which act readily upon deadmatter. A living being preserves itstemperature, to a great degree, underopposing circumstances. Animals do notreadily acquire the temperature of a heatedatmosphere, nor of a cold one ; but pre-serve, in such circumstances, that degreeof heat which is natural to them. Thusthe human body is very nearly of thesame degree of heat in winter as in sum-mer,-in hot as in cold climates. An eggresists freezing for a long while, thoughplaced in the coldest medium: that is, aslong as its living principle remains. Deprive

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it of this by an electric shock, or by de-stroying its texture by mechanical violenceor by agitation, or by previously subject-ing it to any extreme of temperature, itno longer resists the application of heat orcold, but obeys the common laws of in.animate matter. Saccharine matters,which in common circumstances readilyundergo fermentation, suffer no such

change in the stomach of living animalswhile they are in health. Putrefaction ofanimal substances also ceases to go on, inthe same situation. A living egg remainsin the midet of a mass of putrefying ani-mal and vegetable matters ; but depriveit of life, by any of the above mentionedmeans, and it immediately hastens to

decomposition and decay. It is thus, also,that our bodies often resist various Icauses of disease-as contagion, and heatand cold, without being disordered bythem. This power of resistance, how.ever, has its limits ; and is not sufficientat all times to guard us against the ap-proach of* disease.When, by disease, the vital powers be-

eome greatly reduced, either in the wholebody or in particular parts, the body be-comes in consequence less able to resistthe influence of other agents. Thus it is,that vegetable matters undergo fermen-tation in weak stomachs ; and, in thisway, acidity of stomach is produced.Thus also, the body, when weak, is moresusceptible of the influence of miasmataand contagion ; that is, its powers of re-sistance are diminished, by the diminutionof vital power.At my next lectnre, gentlemen, I shall

speak of the other characteristic proper-ties of life.

LECTURESON SOME

PRACTICAL POINTS OF SURGERY,DELIVERED TO THE

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

LECTURE II.

Gentlemen,At onr last meeting I made some obser-

vations on the more common defects inmedical education : the subject of the

present lecture, is the Investigation ofdisease,

In addressing you as friends andfellow-students, I show you the confi.dence I place in your zeal for profe‘sionalknowledge, by my consciousness of howmuch I must trust to your indulgence inwhatever relates to the manner of com-municating that information which I hopeto render useful to you. Actively engagedfrom early life in the duties of the pro-fession to which I am devoted, my leisuremoments have been chiefly directed toobviate the recurrence of those anxieties,which every surgeon must occasiouallyexperience, by the careful observation ofdisease and its consequences; by somereading, and not a little reflection. Thuscircumstanced, the occasions for deliver-

ing my sentiments in public have beenfew, and my inclination to make use ofthem still less frequent.A living author, whose perseverance

and successful exertion to extend th6science, and improve the practice of sur-gery, entitle him to the gratitude of thecommunity, has observed :" If we go into a court of law, we see

the bench occupied by the learned judges;before them are counsel skilled in the

law, and a jury of twelve honest men, tohold the balance betwixt the severity ofthe law and the weakness of human na-ture. What are they met to decide?

Perhaps a matter of money or of stieces-sion. Even if it should be a criminal court,what a contrast have we with the situ-ation of the snrgeon, on whose singledecision the life of a fellow-creature de-pends, one, perhaps, bearing all the

relationships of society; having all theties which bind a man to existence, andthe virtues which make his life dear. Thesurgeon cannot lean upon the judgmentof others, nor say, for this the wisdom ofthe legislature has provided. He has toexamine an evidence often strangelyperverted ; he must judge, unaided byfriendly counsel ; and, to determine uponwhat is right to be done, when the life ofa friend hangs on the issue, and wherethe execution depends on his own-dex-terity, is a thing of the greatest difficulty.’Arduous as the performance of opera-

tions may be, the judgment required todecide on the propriety of operations isequally important; since however skilfulan operator may be, if an operation beperformed without necessity, it is a dread.ful infliction:—if neglected when neces-sary, the patient’s life may pay the for-feit. That the medical profession mustbe a blessing or a curse, according to the

endowments or ignorance of those whoundertake its duties, must be,sufficiently

obvious.In pointing out some of the prominent