Chapter 16

The remedies for this diseased state of the urine, found most successful by Dr. PROUT, are,--opium, in from one to five grain doses, repeated two or three times a day, until the unnatural irritability of the system is relieved,--the same remedy in more moderate doses, in conjunction with the mineral acids, cinchona, uva ursi, and the different preparations of iron,--a large pitch, soap, or galbanum plaster to the loins,--and setons or issues in the back, when the disease manifestly arises from local injury. With respect to the bowels, Dr. PROUT remarks, that they are very difficult to regulate. He has occasionally seen serious consequences to arise from the exhibition of a small dose of calomel, such as diarrhoea and debility, much aggravating the disease, and endangering the life of the patient. For the regulation of the bowels, small doses of castor oil, and laxative injections are most to be relied on; while saline purgatives, more especially Rochelle salt and Seidlitz powders, as containing vegetable and therefore destructible acid, must be avoided.[24] Mercury, in all its forms, is also inadmissible.

"Alkaline remedies of every description, must be most carefully avoided, their use in every point of view being most mischievous when the phosphates are concerned. Indeed all remedies that act as diuretics should, in general, be shunned, and the patient should be prohibited from drinking too much. With respect to drinks, in general, they should be of a soothing, demulcent character, and prepared with distilled or the softest water that can be procured; as hard waters are literally poison in this form of disease."

The second division of the work under review treats of the mechanical and organic diseases of the urinary organs. This portion of the subject is handled with the same ability as the first. We regret, however, that our space will not permit a further development of the author's views. We trust, nevertheless, that we have imparted to our readers adequate notions of the scope of the work, to render them sensible of its value as a manual of urinary diseases. It is illustrated by a good coloured plate, representing the principal varieties of urinary calculi.

The additions of Dr. COLHOUN consist of foot notes, and paragraphs inserted in the text of the original work. We would not, however, wish to be considered as approving of the course, for the most part pursued by Dr. C., of inserting his amplifications in the text of the author, merely distinguished by brackets. Besides the absence of sufficient distinction between the matter of the author and commentator, the text of the former is thus injuriously disjointed, and dependent sentences sometimes widely separated.

In regard to the execution of the present edition, we regret to say that it is wanting in typographical accuracy.

FOOTNOTES:

[23] The reader will bear in mind, that this acid is the same as the uric, the name by which it is generally known.

[24] The reason of this exclusion of salts, containing a vegetable acid is, that they become real alkalies in the course of assimilation by the destruction of their acid, and therefore add alkaline properties to the urine, already too alkaline.

MEDICAL LITERATURE.

ARTICLE XII.--RETROSPECTIVE REVIEW.--_Tractatus de Ventriculo et Intestinis, cui proemittitur alius, de Partibus continentibus in Genere, et in Specie de iis Abdominis._ _Authore_ FRANCISCO GLISSONIO, &c. &c. Lond. 1677, 4to.

As it is not our intention to confine our remarks to the work above mentioned, we shall deem no apology necessary for the somewhat excursive nature of this article, which would not answer our present purpose, if we were obliged to follow the costive details of the venerable FRANCIS GLISSON, whose villanous bad style, and execrable latin, are only to be excused or overlooked in consideration of the great importance of the topics which he handles, and the profound reflections which he makes on them. GLISSON is recognised as author of the physiological term _Irritability_, and as the assertor of the inherent activity of matter. HALLER says of him in his XIth book. "FRANCISCUS GLISSON, qui universis elementis corporum, vim motricem tribuit, etiam nostram vim, Irritabilitatem vocavit," &c.

He was a native of Dorsetshire, and was appointed professor of physic at Oxford in 1627. This post he occupied during forty years, and is much distinguished by his treatise de vita naturæ, and by the work which forms our caption. As he is the first who used the physiological term irritability, we have thought that some researches on this subject in general, and more particularly on his peculiar sentiments, might profitably occupy our retrospective department; for it is very evident that this subject is in general but vaguely discussed, both in medical writings and conversation.

The ancient philosophers did not agree among themselves as to the nature and origin of matter; some of them considering it as eternal in its essence, and others as mutable and changeable in form. The theory of atoms, published by DEMOCRITUS, and subsequently carried out so elaborately by EPICURUS and his disciples, seems to have reached even to our own times, with an increasing reputation and acceptance. According to this theory, the kinds of matter, or elements, must he regarded as infinitely various. HERACLITUS, who taught philosophy about 550 years before Christ, considered all things as derived from an elemental heat or fire;[25] a philosophy which seems to us to have formed the basis of the Hippocratic doctrines of life. Like HERACLITUS, HIPPOCRATES tells us, that the calidum was the first principle of things, and that by an expansion or extension of itself, it constitutes all the objects of the material world. He expresses himself in the following manner. That which we call warmth, or heat, seems to me to be something immortal; something which comprehends all things, which sees and knows all things, as well present as future. Thus assuming as a basis, that the calidum is an almighty, all-wise being, or in other words, a God, all in all, the cosmogony was developed as follows: Chaos he regarded as that condition of the calidum, which preceded any exertion of the Almighty faculties. In emerging from the chaotic state, the greatest part of the heat having assumed the uppermost place, formed the æther; another part having gained the lowermost place, constituted earth; a third portion, midway between earth and æther, became air; and a fourth part, establishing itself between the two latter, became water. So that by means of the extension of this all-wise, elemental calidum, we have the four elements, earth, air, fire, and water, out of which are ultimately composed all the aggregates of the material world.[26] Now, to apply this general principle to the formation of the living being man, who seems to be a sort of microcosm in himself, we are told, that that portion of heat which remained with earth, being expanded and spread abroad in divers places, in some more, in others less, the earth became dry, and something like membrane or pellicle was formed; the matters contained in which, being heated as by a sort of putrefaction, some parts became bone, some nerve, some veins and their contents, and some formed the cavities and their contents, as the urinary bladder, for example.[27]

The full exposition of the opinions of HIPPOCRATES was left for GALEN, and we prefer to make reference to him on this theory, which by his genius and talent was so much embellished, that it became the glory of science, exercising an almost undisputed authority during a long lapse of ages. Indeed the gigantic intellect of this great man, still continues to shed its vast illumination over the world of science, particularly that of medicine; which, if it owes its birth to the divine old man of Cos, is not less indebted for its nurture and growth to the celebrated native of Pergamus. GALEN is the facile princeps of physicians. His astonishing industry, perseverance, and acquirements, his ingenious arguments, and persuasive eloquence, give him an unquestionable claim to the title of princeps, so long accorded to him; and those who even in the present enlightened period, will study his works, shall find themselves almost irresistibly led away by the charm of his suasion.

GALIEN est le seul des anciens qui ait donné un corps complet de medecine: Quoique formé des débris de toutes les doctrines précédentes, son systeme offre cependant, malgré les contradictions ou il tombe assez souvent, une unité remarquable dans toutes ses parties; un ensemble séduisant, qu'un genie de l'ordre le plus élevé pouvoit seul imprimer à un pareil édifice. Ramenant tout à un petit nombre de principes généraux, qui s'ils ne peuvent satisfaire la raison, fournissent du moins une réponse facile a tout, ce systême dut être adopté avec empressement, et sa fortune ne peut étonner.--_Biographie Medicale, Tom. IV._

GALEN may perhaps be justly regarded as an eclectic; but it is manifest, that he mainly walked after the steps of his great predecessor, and recognised model. The following passage seems to contain ideas not much differing from those of HIPPOCRATES which we have presented above: "Who is there, says he, that judging from the origin and constitution of animated beings, doth not immediately infer the existence of a mind, possessed of wonderful energies, extending to, and pervading every portion of the universe! We every where perceive animals procreated, which are possessed of the most admirable structure, and yet what portion of the universe can be more ignoble than this earth of ours? Yet a grand intelligence is seen to have reached even it from the celestial bodies, which for their beauty are so astonishing, and which, as they are for purity far more excellent than our earth, so they are the seats of intelligences, far more pure and perfect than those which inhabit these lower regions." He proceeds to remark, that animals, worthy of the greatest admiration, are produced out of the slime and mud of ponds and ditches, and even in putrefying vegetables, which, as they indicate the miraculous properties of their author, also show us in what estimation we should hold the higher orders of being. "We may even perceive a rational nature in men, if we refer to such examples as PLATO, ARISTOTLE, HIPPARCHUS, ARCHIMEDES, and many others. If, therefore, in such a colluvies as the human body, (for by what better name can we characterize a mixture of blood, bile, and phlegm,) a mind is formed of such great and excellent faculties, what must we think of the excellence of that which exists in the superior bodies?"

It may be said that GALEN expresses, in these passages, the Platonic dogma of an _anima mundi_. But they certainly agree with the sentiments of HIPPOCRATES; and whether he derived them from the former or the latter, matters not, as both of them have invested matter with certain qualities, which render it active, whether it be so essentially or by the act of the Creator. GALEN may be also regarded as partially an Epicurean; for he insists that there are several sorts of matter, or as we should say, several elements; but he differs from that sect again in affirming for it a passible quality. To show that there must be more than one element, or kind of matter, he says, that if there was only one element, or a unit, it would be impassible; it could undergo no change whatever. For there would be nothing by which it could be made to suffer any alteration, or into which it could be altered. Whatever is changed, is changed into something else, and whatever suffers, suffers from something extrinsic: therefore he affirms, that of necessity there must be several sorts of matter, or elements. He says, "there are only two theories on this subject deserving our attention; one of which affirms that sentient bodies are composed of elements possessing the faculty, (cum patiendi tum sentiendi,) both of suffering and perceiving an alteration;" while the other affirms that such bodies are formed (ex patibilibus, sed sensu expertibus) out of passible, but not sentient elements. Neither of these doctrines does he consider tenable, so long as only one element is affirmed, as earth, air, or fire alone, which could never become capable of that great variety of actions we witness in living bodies: but, admit several elements, and we suppose that the mutual interchange of powers would yield a compound body, capable of all the vital phenomena. Such, therefore, says he, as consider the human body to be composed of fire, air, earth, and water, mutually transmuted, alternated, and reduced to a given temperament, and thereby vested with a sentient faculty, speak reasonably; and it is evident that there must be more than one element, and that these elements are passible bodies.

PLATO had taught, that, though all bodies are formed of matter, yet matter itself is not a body; and the same idea is conveyed by ARISTOTLE, in the Lib. de partibus animal. & earum causis, II c.i. "Prima statui potest ea quæ ex primordiis conficitur, iis quæ nonnulli elementa appellant terram dico, aquam aërem & ignem: sed melius fortasse dici potest ex virtutibus confici elementorum, iisque non omnibus sed ut ante expositum est humiditus enim, & siccitas, & caliditas, and frigiditas, materia sunt corporum compositorum."

GALEN also states, that in fire there exists a perfect heat and dryness, in earth a perfect coldness and dryness, and so on of the rest of the elements. For you cannot expect to find in nature a perfectly simple and isolated element; because they are always mixed two or more together. Hence the real terram, aquam, aërem, and ignem, become rather a metaphysical abstraction, than a real entity. That is to say, matter has no real existence, but is mere quality; for earth is not the mere representation of dry or siccum; it is the representative of siccitas, or dryness: fire is not the eidolon of calidum, but of caliditas; water of humiditas, and air of frigiditas. Yet all these elements are in nature possessed of more than one property. Fire is hot and dry, earth is dry and cold, water is cold and moist, &c. If we refer, however, to his account of the soul, we perceive at once, that these inseparable qualities of the elements are the real active agents of life. He plainly declares, that the soul is the mere result of organization, and perishes with the structure in which it dwells. He thinks, "corporis temperiem censendum est." As to the active powers of the four primary qualities, he says, "At mihi quidem tam venæ, quam reliquarum particularum singulæ, ob certam quandam temperiem quam ex quatuor sunt qualitatibus nactæ, hoc vel illo modo videntur agere."--De nat. fac. I.

It is plain he thinks, that the elements consist of a materia and qualitas; but they are elemental by the _qualitas_ and not by the _materia_.

After establishing that there are four elements, which are the common and simple bases of all things, he goes on to show, that the proper proportion and admixture of these, constitute the healthy state of living bodies. If the calidum, for example, be unduly increased, the body is destroyed; if it be improperly diminished by excess of the frigidum, it will also perish. The business of the physician is to keep the proportions just and harmonious; but, as no pure element exists alone, the physician must employ the qualitas in conjunction with the materia. These (to make a phrase) substantive qualities, are found in medicines or food, which, like all objects of sense, are either cold, hot, dry, or moist, and available of course in the management of a cold, hot, dry, or moist derangement of the living body.

The elements of the human body exist in the four humours, blood, bile, atrabilis and pituita; and these four humours correspond in quality with the elements. Blood, which is the reservoir or continent of them all, is a temperate humour. Bile, being the representative of calidum, is hot and dry. Melancholy represents, in our microcosm, the element earth or siccum, and is dry and cold. But pituita, which is moist and cold, corresponds with the humidum element. Air exists in animals nearly pure, as we learn from the phenomena of the pulse and of respiration. It answers to frigidum.

He shows us in his lib. de naturalib. facultat. that, out of the humours, all the parts are formed, and these parts are either _similar_ or _dissimilar_; i. e. simple or compound. Bone is a similar part, that is, it is a simple part; so is an artery, or vein, or ligament. Each of these is so constituted, as that it has a predominance of one element in its nature; and it is therefore dry, or cold, or moist, &c. But if an adust element be, by accident or disease, accumulated in a part naturally cold, the function of such part is morbidly affected. The natural tendency, however, of similar humours to unite, causes each part to receive its regular supply; a principle which BICHAT has since characterized as, _contractilité organique insensible_.

To show the wonderful simplicity of the Galenical system, which for plainness and easy attainment may be compared with the improved nomenclature of chemistry, we will cite a passage from ARGENTERIUS, who, perhaps, was as learned in this kind of lore as any man of his time. In his Tractatio de calidi significationibus, he says; "If any body would undertake to give a general enumeration of those circumstances, in which this term calidum and the others (frigidum, humidum, &c.) are applicable to the explanation of this warmth, he shall find truly, that they are the elements, the humours, the parts, the whole body, medicines, food, air, climate, the weather, the season of the year, and even ages; for these all are either temperate, or hot, or cold, or humid, or dry."

The animal body is moved and governed by two principles; one of them corresponds to the _vie animale_ of BICHAT, and the other to the _vie organique_. Since the power of sensation and of voluntary or elective motion, says he, is a property of animals, and since that of growth and nutrition is common both to animals and plants; the former may be called attributes of the soul, and the latter attributes of nature. Whence we say, that animals are governed by the soul and by nature, while plants are governed by nature alone.

The powers of the body are faculties; and these are either natural, vital, or animal: but they are so subdivided, that we have as many faculties as there are sorts of action. Under the class of natural faculties, we find three principal sorts; to wit, a facultas generatrix, an auctrix, and a nutrix. But if you ask, says GALEN, how many faculties there be, which result from the action of these on each other, you will find them as numerous and diverse as there are numbers and diversities of the animal parts. For example, we have an attractrix faculty, a retentrix, alteratrix, expultrix, &c. &c., all of which are variously modified, according to the nature of the similar or dissimilar parts they are exercised in, or, in other words, according to the nature of the tissues or organs, in which they reside.

Need we go further to show, that GALEN, believing all matter essentially conjoined with the hypothetical caliditas, frigiditas, &c. &c., taught that it was gifted with such a degree of inherent activity, as to render it capable under certain states of combination, of exhibiting all the phenomena of organic and animal life? It is certain that he regarded these active qualities, as the causes of all the phenomena, whether of living or dead matter.--GLISSON ought not certainly then to be regarded as the author of this dogma in medical philosophy. PLATO certainly taught it. VAN HELMONT could not get along without investing matter with what he called a "seminal likeness, which is the more inward spiritual kernel of the seed," &c. But we will let him speak for himself. "Whatsoever," says V. H., "cometh into the world, must needs have the beginning of its motions, the stirrer up and inward director of generation. Therefore all things, however hard and thick they are, yet before that their soundness, they inclose in themselves an air, which representeth the inward future generation to the seed in this respect fruitful, and accompanies the thing generated, even to the end of the stage: which air, although it be in some things more plentiful, yet, in vegetables it is pressed together in the show of a juice, as also in metals it is thickened with a most thick homogeniety or sameliness of kind. Notwithstanding this gift hath happened to all things, which is called _archeus_, or chief workman, containing the fruitfulness of generations or seeds, as it were the internal efficient cause; I say that workman hath the likeness of the thing generated, unto the beginning whereof, he composeth the appointments of things to be done. But the chief workman consists of the _conjoining of the vital air_, as of the matter, with the seminal likeness, which is the more outward spiritual kernel, containing the fruitfulness of the seed; but the visible seed is only the husk of this. This image of the master workman, issuing out of the first shape or idea of its predecessor, or snatching the same to itself out of the cup or bosom of outward things, is not a certain dead image, but made famous by a full knowledge, and adorned with necessary powers of things to be done in its appointment; and so it is the first or chief instrument of life and feeling. But since every corporeal act is limited into a body, hence it comes to pass, that the archeus, the workman and governor of generations, doth clothe himself presently with a bodily clothing. For in things soulified, he walketh thorow all the dens and retiring places of his seed, and begins to transform the matter according to the perfect act of his own image; for here he placeth the heart, but there appointeth the brain, and he every where limiteth an unmoveable chief dweller, out of his whole monarchy, according to the bounds of requirance of the parts and appointments. At length that president remaineth the overseer and inward ruler of the bounds, even until death; but the other, floating about and being assigned to no member, keeps the oversight over the particular pilots of the members, being clear and never at rest or keeping holiday."

Notwithstanding the affected and euphuistic jargon of the above passages, it is evident that VAN HELMONT'S idea is very similar to that of GALEN. By seminal likeness, we are to understand an aptitude in matter to take on certain determinate forms, and this may be supposed to differ not very essentially from those laws, which govern matter in crystallization. But even this seminal likeness, as we perceive, is a sort of abstraction, very analogous to the Galenical caliditas; for it is the more inward spiritual kernel of the seed, whereby the matter is enabled to enjoy a certain degree of activity, the degree of which is much increased by the union of the air, or archeus, with it. So the caliditas of GALEN, which, after all, is matter, gives to its subject the powers which it enjoys. GLISSON, speaking of the natura seminalis, says that it is a certain or specific essence, superadded to mere elementary principles, by means of which mixt bodies adopt certain determinate forms, and acquire the faculty of performing essential operations, more noble than those which belong to naked elements.

We regret very much that we have been unable to procure a copy of GLISSON'S treatise de vita naturæ, which, so far as we know, can not be had in this country. We shall, therefore, furnish our readers with the following passage from the Biographie Medicale, from the pen of JOURDAIN.