La médecine expectante is still the favourite method of practice with many of the French physicians. I cannot undertake to say how generally. When the principle is directed by a clear judgment, there is much in it to be admired. A constant and too officious interference by means of active medicines, may do serious injury to the powers of the constitution; and, on such terms, the remedy may be worse than the disease: but, on the other hand, to look on passively as a spectator, and witness the formation of disease, forbearing all active treatment until formidable symptoms take place, seems more reprehensible even than excess of zeal in the use of medicine. I approve the maxim, Venienti occurrite morbo.
In inflammations of the most important organs of the body, if we allow delay, or want decision, the moment of being useful soon passes away. It is incumbent upon us always to pay due attention to natural indications, and to consider nature in the light of a good physician; but I maintain that, in all instances of acute disease, and for the most part in chronic, we may interpose our aid with certain benefit, if we form a correct diagnosis, and come armed with just principles of practice.
Within the last few years, new medical doctrines[6] have been introduced in France, by M. Broussais, Professor at the Hôpital du Val-de-Grâce at Paris; of which, the most important part relates to the inflammation of the mucous membrane of the alimentary canal. This inflammation is divided into acute and chronic, and is denominated according to its situation; gastrite, when affecting the stomach; gastro-enterite, when it extends from the stomach to the small intestines; and colite, when confined to the colon.
The great importance of the functions of the stomach and intestines, and the active sympathies which the stomach especially exchanges with every part of the body, almost as a centre of the nervous system, is one of the medical truths first taught in our schools, and is constantly demonstrated to our observation, both in health and sickness. But M. Broussais has extended to an unauthorized length, his theories founded on the inflammatory affection of the mucous membrane of the digestive canal; so that, if I mistake not, he assigns to it almost an universality of influence.
Our acquaintance with the gastro-enterite, is a key to the whole pathology of this Professor, who has taken a great lead in Paris, and formed a school of his peculiar doctrines. He considers that all the essential fevers of authors are only various forms of sympathetic phenomena, arising out of a gastro-enterite; that all the pretended nervous affections of the stomach are the result of a chronic gastrite; that the various dangerous disorders of the brain, for the most part, owe their origin to the state of the digestive passages, irritated with chronic disease; that in all the febrile phlegmasiæ, the stomach and small intestines are irritated in the commencement, if not during the whole progress of the malady; that the gout depends commonly on a chronic gastro-enterite, “which prepares and supports the irritation of the joints.”
He considers that gastrite rarely exists alone, and that it is almost constantly joined with an inflammation of the small intestines.
He does not admit that there is any essential difference in the nature of gout and rheumatism.
This is a very concise epitome of the doctrines of M. Broussais, and is offered only as an outline.
The practice which is founded on this view of most of the diseases of the body is remarkably simple, and may be almost included in the free and repeated application of leeches to the most affected part of the abdomen; the use of fomentations and poultices to the seat of irritation; of emollient lavemens; of tisanes calculated to allay irritation; of the mildest nutriment, as veal broth with rice; also the greatest care is used to avoid every irritating material, whether medicinal or dietetic; and, to favour all these means by entire repose and time. The gravest fevers of the East and of the West; the plague itself; the fevers of our own country, continued or intermittent, typhoid or inflammatory, and the phlegmasiæ, appear to be all arranged under the same general principle of treatment.
From the observations which I had the opportunity of making at the hospitals in Paris, and from the attention I have since devoted to the examination of these doctrines, I am far more inclined to borrow, occasionally, from the opinions of M. Broussais, than implicitly to follow his theory or practice.