In the two last lectures I have attempted to investigate the laws of life. I now proceed to the most important part of our course, and for which all the preceding lectures were intended to prepare us; I mean the application of the laws of life to explain the nature and causes of diseases, and the methods of curing them, which must always be imperfect, and conjectural, unless the nature of the diseases themselves be well understood.
We have already seen that life is constantly supported by the action of the external powers which surround us, and that if the action of these powers be properly regulated, and at the same time no other powers be suffered to act on the body, we shall enjoy perfect health, but if, on the contrary, the exciting powers which support life, act either too feebly or too powerfully, then the functions will not be performed with precision and vigour, but irregularly; the mind and body will become deranged, and death will often take place many years before the natural period at which that event might be expected.
As health is the greatest blessing which man can enjoy, it is natural to think, that in the early ages of society, when men began to lose sight of the dictates of nature, and feel the torture of disease, they would regard with gratitude those who had contributed towards their relief, and that they would place their physicians among their heroes and their gods. In the early ages, however, diseases would be very few, for it would not be till civilisation had made considerable progress, that such unnatural modes of life as conduce to their production, would take place.
As the first professors of physic knew nothing of the animal economy, and little of the theory of diseases, it is evident that whatever they did, must have been in consequence of mere random trials. Indeed it is impossible that this or any other art could originate in any other manner. Accordingly history informs us that the ancient nations used to expose their sick in temples, and by the sides of highways, that they might receive the advice of every one that passed.
It would take up too much time to pursue the history of medicine from this rude origin, through all its changes and revolutions, till the present time: let it therefore suffice to say, that after various theories had been invented and overturned, and after one age had destroyed the labours of another, though different branches of the healing art, and particularly anatomy, had been enriched with valuable discoveries, still a rational theory was wanting; there was nothing to guide the practitioner in his way, and we may truly say that till the laws of life, which I have been endeavouring to illustrate, were investigated by Dr. Brown, medicine could boast of no theory which had a title to be called philosophical.
The theories of Stahl, Boerhaave, and Cullen, have passed away, and are almost forgotten, but this, which is founded on nature, and on fact, will, like the Newtonian philosophy, last for ever. It has already influenced the practice of medicine, and is taught in almost all the schools of Europe and America. In this country it seems to have had less attention paid to it than it deserved, because its influence was counteracted by the arrogance and profligacy of its author, as if the grossness of a man's manner affected the conclusiveness of his arguments; but this influence did not extend beyond Britain, while the light of his theory illuminated the opposite hemisphere. And when the manner in which he was persecuted is recollected, the liberal mind will allow something to the deep consciousness of neglected merit.
A circumstance much in favour of this doctrine is, that those who understand its principles thoroughly, are guided by it in their practice with a certainty and success before unknown. I say those who understand its principles, for these were not perfectly understood even by the author himself. He first saw with his mind's eye the grand outline of the system, from which, for want of proper reflection, he often drew wrong deductions, and which he often applied improperly. But whatever errors Brown may have committed in the application of his system, and however short his doctrines may fall of a perfect system of medicine, we may venture to predict that the grand outlines will remain unshaken.
From what has been already shown, it must be evident that if the just degree of excitement could be kept up, mankind would enjoy continual health. But it is difficult, if not impossible, to regulate the action of the exciting powers in this equable manner, and if their action is increased, the first effect they produce on the functions is to increase them, and the next is, to render them disturbed or uneasy; or, in other words, to bring on diseases of increased action, or what have been called inflammatory or phlogistic, both of which terms are improper, as they convey false ideas, and are connected with erroneous theories: Dr. Brown has given the name of sthenic to these diseases, from their consisting in increased strength or action, and this is certainly a more appropriate term. On the contrary, when the action of the exciting powers is diminished more than is natural, the functions become languid and disturbed, and by a still further decrease of the action of these powers, they become irregular and inordinate. This state of the body, which is opposite to the former, Dr. Brown has denominated asthenic.
But the stimulant powers may act so powerfully, and exhaust the excitability to such a degree, that they may overstep the bounds of sthenic or inflammatory disease and bring on debility. Debility may therefore arise either from the stimuli acting too weakly, or from a deficient excitability, while the stimulus is not deficient. Debility produced in the former manner is called direct debility, and in the latter indirect debility.
To explain this more clearly, let us take a common instance. If a person by any means be deprived of the proper quantity of food, he will feel himself enfeebled, and the functions will gradually grow more and more languid, and at last become irregular, and be performed with pain. This state is called direct debility. Here is excitability enough, and even too much, for it has accumulated by the subtraction of a stimulus; but here is a deficiency of excitement from defect of stimulus.