Page:Encyclopædia Britannica, Ninth Edition, v. 15.djvu/845

Rh HISTORY.] MEDICINE 813 investigation by which the systems were ultimately super seded. These are physiology in the modern sense, as dating from Haller, and pathological anatomy, as dating from Morgagni. Albrecht von Haller (1708-77) was a man of even more encyclopaedic attainments than Boerhaave. He advanced I chemhtry, botany, anatomy, as well as physiology, and was incessantly occupied in endeavouring to apply his scientific studies to practical medicine, thus continuing the work of his great teacher Bcerhaave. Besides all this he was probably more profoundly acquainted with the litera ture and bibliography of medicine than any one before or since, Haller occupied in the new university of Gottingen (founded 1737) a position corresponding to that of Boerhaave at Leyden, and in like manner influenced a very large circle of pupils. The appreciation of his work in physiology belongs to the history of that science; we are only concerned here with its influence on medicine. Haller s definition of irritability as a property of muscular tissue, and its distinction from sensibility as a property of nerves, struck at the root of the prevailing hypothesis respect ing animal activity. It was no longer necessary to suppose that a half conscious &quot;anima&quot; was directing every move ment. Moreover, Haller s views did not rest on a priori speculation, but on numerous experiments. He was among the first to investigate the action of medicines on healthy persons. Unfortunately the lesson which his contempor aries learnt was not the importance of experiment, but only the need of contriving other &quot;systems&quot; less open to objec tion ; and thus the influence of Haller led directly to the theoretical subtleties of Cullen and John Brown, and only indirectly and later on to the general anatomy of Bichat. The great name of Haller does not therefore occupy a very prominent place in the history of practical medicine. The work of Giovanni Battista Morgagni (1682-1771) had and still preserves a permanent importance beyond that of all the contemporary theorists. In a series of letters De sedilus et causis morborum per anatomen indayatis, pub lished when he was in his eightieth year, he describes the appearances met with at the post-mortem examination as well as the symptoms during life in a number of cases of various diseases. It was not the first work of the kind. Bonet had published his Sepulcretum in 1679 ; and obser vations of post-mortem appearances had been made by Montanus, Tulp, Yieussens, Yalsalva, Lancisi, Haller, and others. But never before was so large a collection of cases brought together, described with such accuracy, or illustrated with equal anatomical and medical knowledge. Morgagni s work at once made an epoch in the science. Morbid anatomy now became a recognized branch of medical research, and the movement was started which has lasted till our own day. The contribution of Morgagni to medical science must be regarded as in some respects the counterpart of Syden- ham s. The latter had, in neglecting anatomy, neglected , the most solid basis for studying the natural history of disease ; though perhaps it was less from choice than be cause his practice, as he was not attached to a hospital, gave him no opportunities. But it is on the combination of the two methods, that of Sydenham and of Morgagni, that modern medicine rests ; and it is through these that it has been able to make steady progress in its own field, inde pendently of the advance of physiology or other sciences. The method of Morgagni found many imitators, both in his own country and in others. In England the first important name in this field is at the same time that of the first writer of a systematic work in any language on morbid anatomy, Matthew Baillie (1761-1823), who published his treatise in 1793. Cullen and Brown. It remains to speak of two system atic writers on medicine in the 18th century, whose great reputation prevents them from being passed over, though their real contribution to the progress of medicine was not great Cullen and Brown. William Cullen (1712-90) was a most eminent and popular professor of medicine at Edinburgh. The same academical influences as surrounded the Dutch and German founders of systems were doubtless partly concerned in leading him to form the plan of a comprehensive system of medicine. Cullen s system was largely based on the new physiological doctrine of irritability, but is especially noticeable for the importance attached to nervous action. Thus even gout was regarded as a &quot; neurosis.&quot; These pathological principles of Cullen are contained in his First Lines of the Practice of Physic, an extremely popular book, often reprinted and translated. More importance is to be attached to his Nosology or Classification of Diseases. The attempt to classify diseases on a natural history plan was not new, having been commenced by Sauvagcs and others, and is perhaps not a task of the highest importance. Cullen drew out a classification of great and needless com plexity, the chief part of which is now forgotten, but several of his main divisions are still preserved. It is difficult to form a clear estimate of the importance of the last sys tematizer of medicine, John Brown (1735- 88), for, though in England he has been but little regarded, the wide though short-lived popularity of his system on the Continent shows that it must have contained some elements of brilliancy, if not originality. His theory of medicine professed to explain the processes of life and disease, and the methods of cure, upon one simple principle, that of the property of &quot; excitability,&quot; in virtue of which the &quot;exciting powers,&quot; defined as being (1) external forces and (2) the functions of the system itself, call forth the vital phenomena &quot; sense, motion, mental function, and passion.&quot; All exciting powers are stimulant, the apparent debilitating or sedative effect of some being due to a deficiency in the degree of stimulus; so that the final conclusion is that &quot; the whole phenomena of life, health as well as disease, consist in stimulus and nothing else.&quot; Brown recognized some diseases as sthcnic, others as asthenic, the latter requiring stimulating treatment, the former the reverse ; but his prac tical conclusion was that 97 per cent, of all diseases required a &quot;stimulating&quot; treatment. In this he claimed to have made the most salutary reform because all physicians from Hippocrates had treated diseases by depletion and debili tating measures with the object of curing by elimination. It would be unprofitable to attempt a complete analysis of the Brunonian system ; and it is difficult now to understand why it attracted so much attention in its day. To us at the present time it seems merely a dialectical construction, having its beginning and end in definitions, the words power, stimulus, &c. 5 being used in such a way as not to correspond to any precise physical conceptions, still less to definite material objects or forces. One recommendation of the system was that it favoured a milder system of treatment than was at that time in vogue ; Brown may be said to have been the first advocate of the modern stimulant or feeding treatment of fevers. He advocated the use of &quot;animal soups&quot; or beef tea. Further he had the discern ment to see that certain symptoms, such as convulsions^and delirium, which were then commonly held always to indi cate inflammation, were often really signs of weakness. The fortunes of Brown s system (called, from having I originally written in Latin, the Brunonian) form one of the strangest chapters in the history of medicine. In Scotland, Brown so far won the sympathy of the students that no conflicts took place between his partisans and oppoi In England his system took little root. In Italy, 01 other hand, it received enthusiastic support, and, uatu