LOCAL DISEASES," OTHERWISE "MY BOOK."
"From the barr'd Vizor of Antiquity1
Reflected shines the Eternal light of Truth,
As from a mirror; all the means of action,
The shapeless masses, the materials,
Are everywhere around us. What we need
Is the celestial2 fire, to change the flint
Into transparent3 crystal, bright as fair."
Longfellow's "Spanish Student."
In all that Abernethy had hitherto published, it was easy to perceive that, although he was carefully examining the prevailing5 opinions and practice of the day, he was emphatically one of those independent thinkers who had power to overlay the most established conventionalisms with opinions of his own. Although hitherto his publications had related to particular diseases or accidents which were held as within the ordinary province of the surgeon, he was shadowing forth7 principles—views which, if they were true, must necessarily have a much wider range of application than to the particular cases which it had been his object to consider. In 1804, he had sufficiently8 matured his general views to think it right to publish them; and this he did in his book on the "Constitutional Origin of Local Diseases," popularly known as the "My Book," to which he not unfrequently referred his patients for a more detailed9 account of his views, than he could find time to give in the consulting room. When we reflect that diseases consist entirely10 of altered conditions in the structure or function of some part of the body, a formal announcement that127 they must be greatly influenced by the organs on which the whole body depends for its nutrition, seems to have so much the aspect of an obvious truism, that we scarcely know whether most to wonder at so formal an announcement of it having been necessary, or the astonishing number and variety of the reservations with which it has been admitted.
But, strange as this may appear, and although all the facts have been before the eyes of man for ages—nay11, though their relations have been more or less felt and acknowledged in cases usually submitted to the physician,—we venture to say that nothing like an attention at all adequate to their importance was obtained for them in the practice of physic, and scarcely any at all in surgery, until the time of Abernethy.
At the present time, a great deal has been done to establish, by the most clear and indisputable demonstration12, the practical usefulness and necessity of the principles to which Abernethy conducted us, in the cure of diseases, whether medical or surgical13. Still, these principles are much neglected, much misunderstood, or so imperfectly carried out, as to excite, even in many of the public, expressions of astonishment14. It is, indeed, not too much to assert, that, even in those cases in which their successful application has been most incontestibly exemplified, his principles are fully4 carried out on comparatively few occasions.
The causes of all this are, we fear, too easily detected; the removal of them is indeed sufficiently difficult. We may possibly discuss both points in the sequel.
Instead of the exquisite15 simplicity16 and clearness of Abernethy's views, so far as he had gone, being carefully studied, and with a view to the extension of them beyond those limits which his time, his opportunities, and his caution had assigned to them; instead of examining into, and testing, the practical value of the deducible, and, in fact, necessary sequences, on views of which he had demonstrated the truth and value; practice appears to have taken a retrograde movement.
He who would advance even as far as Abernethy, is in danger of being regarded as crotchety or peculiar17; whilst any who should strive by a more careful examination of his views to render their128 practical application more definite and analytical18, must be prepared to be looked on simply as an enthusiast19.
This has, indeed, been the case more or less in all sciences from the earliest times. The facts which conduct us to a true interpretation20 of the laws in obedience21 to which they occur, have been always before us; the very same facts on which, as Professor Whewell29 observes, we have raised the stately structure of modern science. Butler30 had before made a similar remark. Poets too, as even the motto to our chapter shows, have held the same sentiment; what everybody knows, how few consider! Neither Copernicus nor Galileo altered or invented facts. Those they observed! what they discovered, were conclusions interpreting the true relations of them. Bodies fell to the earth, and the crystal rain-drop had shown the composite nature of light in the beautiful colours and wonderful illustrations of the rainbow, ages before Newton discovered the true explanation of the one, and the great law exemplified in the other.
The object of "the Book" is to set forth the great fact of the reciprocal influence existing between the nervous system and the digestive organs, and the power they mutually exert in the causation and cure of diseases; and this, whether the diseases originate in disturbance22 primarily directed to the brain or any other portion of the nervous system, or to the digestive organs; whether the result of accident, such as mechanical injury, or other local manifestations23 more commonly termed disease. In the book before us we shall find an ample refutation of many misconstructions and misapprehensions of Abernethy's views; misconstructions which have tended to obscure principles, remarkable24 for their simplicity and truthfulness25; to impede27 the beneficial application of them in a manner which has been equally injurious to the public and the profession, and which, have impressed on mankind a very inadequate28 idea of the obligations due to the distinguished29 author. His views were said to be theoretical and exaggerated, whilst they were conclusions logically deduced from facts; and so far from the pervading30 power of the influences to which129 he proximately attributed the causation and cure of disease having been exaggerated, the onward31 study of his principles only serves, by the discovery of more multiplied and refined applications of them, to fill in with additional illustrations the accurate outline which he has so truthfully drawn32. He never wrests33 a fact to a conclusion to which it does not legitimately34 lead. In virtue35 of that suggestive quality of his mind (so important an aid in philosophical36 inquiries37), he occasionally, in all his writings, puts forth suppositions, but these only as questions, the next in the order of inquiry38, and these he asks of nature alone.
Mr. Hunter had been the first in this country to make the true use of anatomy39; I mean in the sense that whilst it was no doubt the basis of our investigation40 into the functions or uses of parts, still it was only one of an extensive series of inquiries. He had examined the dead with no purpose more earnestly, than to assist him in his endeavours to observe the living; examined parts, that he might better understand the whole. He had made himself familiar with the economy of animals, and generally with the habits of organized beings, whether animal or vegetable, that he might know their relations to each other, and that of the whole to the phenomena41, habits, and laws, of the Human economy. As he neglected no source whence it had been customary to seek for information, so, notwithstanding his fondness for animals, he made various experiments on living creatures. But whilst these experiments afford additional proofs of the poverty, so to speak, of this plan of investigation, they impress on us the truth of Sir Charles Bell's assertion, that physiology42 is essentially43 a science of observation. We have only to place Mr. Hunter's observations and experiments here referred to, in juxtaposition44, in order to bring out in high relief the great meaning and value of the one, and the unnecessary, or inconclusive, character of the other. He also examined the various facts presented to him in the living body with unequalled patience and circumspection45.
Amongst others, he had paid particular attention to those which exemplify that vivid, that watchful46 connection which exists between various parts and organs, and by which impressions or sensations excited in any one part are telegraphed, as it were,130 with the swiftness of lightning to any or all of the organs of the body; facts which may be observed by anybody, by no one better, and by few so well, as patients themselves. To take a common example: everybody is familiar with the fact that certain disturbances47 of the stomach produce pain or other annoyance48 in the head. Every one also knows that in such cases there is very often no pain, and sometimes no sensation of annoyance in the stomach; so that were it not from an innumerable succession of such conditions, in connection with particular influences on the stomach, we should, from the feeling of the stomach only, never dream of the cause being in that organ. Now on these simple facts hang not only the most practical of all John Hunter's observations, not only the most valuable of Mr. Abernethy's, but (as far as we can see) those relations through a philosophical examination of which we shall still most auspiciously49 seek to extend our practical knowledge of disease. We see here just that which Mr. Hunter had asserted—namely, "that the organ secondarily affected50 (in this case, the head) sometimes appeared to suffer more than the organ to which the disturbance had first been directed."
He observed also that the connection thus manifested, existed equally between all other parts and organs; that although it might be exemplified in different forms, still the association it implied was indisputable. He adopted the usual terms by which these phenomena had been designated. Parts were said to sympathize with each other, and no term could be better, as it simply expressed the fact of associated disturbance or suffering. It is true the facts were not at all new; they had always existed; nay, they had been observed and commented on by many persons ever since the time of Hippocrates; and if I were to mention the whole of such facts, there is scarcely one which would not be to some one or other as familiar as a headache from disturbance of the stomach. Mr. Hunter, however, had a kind of instinctive51 idea of the yet unseen value of the clue thus afforded to the investigation of disease; and he observed these facts with a greater attention to all their details than any one, or all, who had preceded him.
131
Hunter's observations on the subject in his lectures were extremely numerous, and elaborate even to tediousness; Abernethy, who used to give us a very humorous description of some of the audiences of John Hunter on these occasions, was accustomed to say, "That the more humorous and lively part of the audience would be tittering, the more sober and unexcitable quietly dosing into a nap; whilst the studious and penetrative few appeared to be seriously impressed with the value of Mr. Hunter's observations and inquiries." Mr. Cline, an honoured name in our profession, and one who, had he lived in later times, would probably have been as distinguished in advancing science as he was for his practical excellence52, significantly expressed his impressions of the future importance of the inquiries in which Hunter was engaged. Addressing Mr. Clift, after one of the lectures, he said:
"Ah! Mr. Clift, we must all go to school again."
Mr. Abernethy carefully treasured up and pondered on what he heard. He placed himself as much as he could near Mr. Hunter; took every pains, which his time and occupations allowed, thoroughly53 to understand him; and, with his characteristic tendency to simplification, said: "Well, what Mr. Hunter tells us, resolves itself into this: that the whole body sympathizes with all its parts."
His perceptivity, naturally rapid, was evidently employed in observing the bearing of this axiom on the facts of disease. The digestive organs, which, if we extend the meaning to all those engaged in assimilating our food, compose nearly the whole viscera of the body, could not escape his attention, nor indeed fail to be regarded in all experimental investigations54 of any one organ. Accordingly, in his paper on the skin and lungs, we have seen a very important application of the relations between organs engaged in concurrent55 functions; we have placed before us the physiological56 evidences of their being engaged in a common function, and the sympathetic association it rendered necessary; whence he had observed relations of great moment, and pointed57 out the practical bearing they must have on Consumption. He had, however, been paying attention for some time to the digestive132 functions, when his intimate friend, Mr. Boodle, of Ongar in Essex, gave a fresh stimulus58 to his exertions59. This gentleman requested him to investigate the functions and conditions of the liver in various nervous diseases, as also in certain affections of the lungs, which had appeared to him, Mr. Boodle, to originate in the former organ. Mr. Abernethy says: "I soon perceived that the subject was of the highest consequence in the practice of surgery; for local diseases disturb the functions of the digestive organs, and, conversely, a deranged60 state of those organs, either occurring in consequence of such sympathy, or existing previously62, materially affects the progress of local complaints."
At the very commencement, he hits on a great cause of evil, and boldly assails63 one of the most mischievous64 of all conventionalisms. "The division of medicine and surgery," he observes, "is mischievous, as directing the attention of the two orders of practitioners65 too exclusively to the diseases usually allotted66 to them." There is indeed no exaggerating the evils of that partial mode of investigation to which such a custom almost necessarily leads. We fall into error, not because of the difficulty of the subject, but because we never can, by looking at one set of diseased processes only, learn the whole of the facts belonging to the subject. It was just this that prevented Fordyce from arriving at correct views of fever. Nothing could be more excellent than the way he began to consider it; but he hardly begins, before he tells us that he intends to exclude those febrile affections which fall under the care of surgeons. In doing this, he at once abandoned a series of facts which are absolutely essential to the investigation. It must be obvious, on a moment's reflection, that, if a particular condition of a part have a relation to the whole body, the study of one without the other, or even if both be taken up by different persons, nothing but the most imperfect views can result. A jury, still more a judge, might in some cases guess from partial evidence the issue of a legal investigation; but who ever heard of either determining beforehand to examine a portion only of that evidence? Yet it is not too much to say, that hardly any legal question can be so recondite67 as many inquiries in physiology. The nature of the133 case is always more or less obscured by a number and variety of interfering68 circumstances. Diseases may be regarded, in fact, as nothing more than natural laws, developed under more or less complicated circumstances of interference.
Lord Bacon had warned all investigators69 of Nature of the danger of attending only to a portion of the facts; it had been one of the great bars to progress of knowledge in general. I regret to say that it still continues the bane of almost all medical inquiries.
Abernethy's inference in relation to this mutilated sort of investigation is too true, when he observes that "the connection of all local diseases with the state of the constitution has obtained little notice;" whereas the truth is, that "no part of an animal body can be considerably70 disordered without affecting the whole system." Now here Mr. Abernethy claims—what? Simply this: he claims for function—that is, the various offices fulfilled by the several parts and organs of the body—that which Cuvier has so beautifully insisted on, and which our own Owen has so instructively exemplified in regard to structure or formation; namely, a necessary relation between the whole and all its parts.
In speaking of affections of the nervous system, Abernethy observes that the brain may be affected by the part injured, and that then it may affect the various organs by a "reflected" operation; but that whatever may be the mode (thus carefully separating the opinion from the fact), "the fact is indisputable." He adds that it may affect some organs more than others, and thus give a character or name to a disease. For example, it might affect the liver, we will say, when the name which would be given would probably be expressive72 of what was a secondary circumstance—namely, a disturbance of the liver. This does not so frequently happen, perhaps, nor so mischievously73 in relation to local injuries; but in other cases it is the cause of a great deal of erroneous and misleading nomenclature.
As we have seen, it often occurs that when the organs of the body are disordered, the more salient "symptoms," perhaps the whole of those observed, are referred to a secondarily affected134 organ, and the disease is named from that circumstance. The too frequent result is, that attention is exclusively directed to that organ, whilst the cause, being elsewhere, and where there are no symptoms, wholly escapes observation.
This is a very important branch of inquiry; and as it closely connects what Abernethy left us with what appears to us to be one of the next things to be clearly made out, we will endeavour to illustrate74 it.
Suppose a person meet with a severe injury, a cut, bruise75, fracture, or any thing that we have seen a hundred times before, and, instead of being succeeded by the usual processes of repair, it be followed by some others: the simple expression of the fact is, that something has interfered76 with the usual mode and progress of repair; and as former experience has shown us that there was nothing in the nature of the injury to account for this, we are naturally led to look for the explanation of it in the state of the individual. But if the unusual appearance be one which we have agreed to call "Erysipelas," and we are accustomed to see long papers written upon this appearance as a distinct disease, we acquire a tendency, as every day's experience shows, to regard it as a kind of abstraction, or as an entity77; something composed of precise and definite relations, contained in that particular description of case. Yet these relations may not be in any two successive cases exactly alike. Again, all of them may be subordinate to some more general character, probably a relation without which we cannot readily explain the phenomena; but at which we cannot arrive, because we have not comprehended a sufficient number of facts in our inquiry to include it.
"Erysipelas" is nothing more than a natural law obscured; because, as we have just hinted, it is developed under circumstances of interference (from disordered conditions of the economy) which distort the natural features of the law, modify its effects, or which may prevent altogether its full development. But now, if we study the means afforded by the various links which other varieties of disease furnish, the ascertainment78 of the real relations becomes comparatively easy; and we find that, whilst there are certain general relations which belong to all cases,135 there are certain others which may in a given number in succession be identical; or in no two exactly the same.
Partial investigations, leading, of course, to erroneous views, are sure to entail79 on us a defective80 nomenclature; and then the two do very materially contribute to continue the fallacies of each other. We may have an affection of a lung, perhaps; the cause may not be in the chest at all, although the lung may be inflamed81 or otherwise affected; but we call it Pneumonia82, or Pleuritis, or some other name which simply refers to what is happening to the part; but all such names have reference only to effects; they are extremely defective therefore, as comprehending only a portion of the nature, and having no reference whatever to the seat, of the cause of the malady83. The consequences of all this may not be necessarily mischievous; but they are so lamentably84 common, as to continue to form a very large share of the routine practice. The cause is elsewhere; but the remedies are directed to the chest—that is, they are, in such cases, applied85 to effects, not causes. If we must retain names so defective, it would be very practicable to combine them with something which should indicate that we had, at least, looked for the cause. This would, at all events, encourage a habit of looking beyond mere86 symptoms, and carry us at least one link higher up the chain of causation.
Abernethy, in demonstrating the connection between local disease, or injury, and general disturbance, judiciously87 takes cases where the relation was most unequivocal; that is, where the local disturbance consisted of a mechanical injury; such as in a gentleman who had undergone an operation—in another who had met with a bad fracture of his leg. In order to amplify88 his illustrations of the connection between the brain and all parts with the digestive organs, he draws them from all sorts of sources—from diseases the most severe and dangerous, as well as from affections which are regarded as most common or trivial—from the last stages of cancer and serious diseases of the loins, to the common disturbances of teething in children—sources which, from their apparent dissimilarity, confer, of course, the strongest force on testimony89 in which they combine.
His delineation90 of the features by which disorders91 of the digestive136 organs may be generally detected, is remarkably92 simple, clear, and truthful26.
Every word has the inestimable value also of being alike intelligible93 to the public and the profession. His statement is interspersed94 with remarks of great value, which, we trust, have not passed away altogether unimproved: such as, that he had observed disorder71 of the digestive organs produce states of health "similar to those" said to be characteristic of the absorption of particular poisons—a most recondite subject; but one, the obscurity of which has entirely, as we think, resulted from the determination to regard the diseases to which it refers as abstractions, and to investigate them under the impenetrable shadow of preconceived opinions.
Almost all his remarks have received more or less confirmation95 from the experience of the whole civilized96 world. There are few things in his observations more interesting than the emphatic6 way in which they ignore the vulgar impression that he referred all diseases to the stomach. In the whole round of scientific literature, it would be difficult to find, in the same space, so complete or comprehensive a view of all those which we usually term the digestive organs.
Abernethy was very far from any such narrow views; whilst, in regard to other organs, to which some of our most distinguished men had paid particular attention, it is not too much to say, that, more clear and precise than Curry97, and equally careful with Hunter, not less painstaking98 than our excellent Prout, he is more practically penetrating99 and comprehensive on this subject than any of them. But as to the charge of exclusive reference to the stomach, we shall easily see there was no foundation for it.
In speaking of the reciprocal affections of the brain and the digestive organs, he says: "The stomach is said to be chiefly concerned in producing these effects; but the cause of the sympathetic affection is probably more general." Page 48. He then goes on to exemplify causes acting100 on the Liver, and so forth. Page 49.
He distinctly contends that other of the chylopoetic organs may disturb the brain as well as the stomach. Again, at page137 52, he repeats a similar opinion, and especially adds, that when the alimentary102 canal is affected, we can never be sure that it is primarily so.
He also says, at page 53, that, in some cases, the disorder of the digestive organs is dependent on disease of the brain.
I have alluded103 to these passages, because nothing is more unjust to Abernethy than to suppose that he attributed everything to the stomach, or restricted his attention to that or any other organ. Such a misapprehension also tends indefinitely to impede the practical application of his principles, and to deprive us of the advantages which are so constantly derivable104 from them.
This is so important, that it may be useful to consider a little the circumstances which may have thus misled the public, and we fear, not unfrequently, the profession also, in the interpretation of Abernethy's views.
In conducting the treatment of diseases of the digestive organs, whatever organ we may desire to influence, either by inducing tranquillity105 of the nervous system, or by the selection of food appropriate to the actual condition of the organ specially101 affected, the stomach is necessarily a primary consideration.
The reasons for this are sufficiently obvious, but have not perhaps been always adequately regarded. Digestion106 is, on the whole, a manufacture, so to speak, of a raw material (food) into a fluid (blood), which is to be absolutely adapted to purposes for which it is designed. This is effected not by one, but by several organs, which each produce their respective changes in the materials submitted to them. If we desire, therefore, to adapt the work to any organ which is engaged in this process, however remote it may be from the stomach, which, with the teeth and other auxiliaries107, execute the first process in the manufacture, it is quite clear that we must begin with the first process to which we subject the said raw material or food. Say that in a machine for the manufacture of cloth the spinning apparatus108 were out of order, we must begin by giving out a less quantity of wool to the carding machine, or whatever represented the first process; because, having once delivered the wrong quantity or quality, we have no138 means of recalling it, and we should only still further derange61 the defective machinery109.
So in the body; the liver, kidney, and other organs, not excepting the lungs and skin; their work must all bear relation to the quantity or quality of raw material, whether their function be the manufacture of the new product, or the rejection110 of that which is useless. So that supposing there were no other reason, no other than this mechanical relation (which is very far from the real state of the case), still we must de facto begin with the stomach, even where we entertain no idea of any special derangement111 of that organ. The stomach, however, is very important in another sense, and has a power of indicating the necessity of attention to those points which I have endeavoured to illustrate by the homely112 similitude of a manufacture.
Wherever impressions first act on the body, nature has placed a most vigilant113 guard. This is variously managed in different cases; the result is the same, and, as it would appear, the final cause also. In the eye, there is the most beautiful contrivance for moderating the ingress of light, as also any abrupt114 increase of intensity115. Fringed curtains are provided which can close with electrical celerity. Again, the aperture116 by which light is finally admitted into the eye is vividly117 contractile or expansive, as the occasion may require; then again there are various media of different densities118, through the influence of which even the velocity119 of light undergoes practical retardation120 by repeated refractions; and lastly, there are powers of sensual adaptation in the nerve with which the light is ultimately brought in contact, more wonderful than all.
The ear, being likewise a portal for external impressions, is guarded with equal care. Not a single vibration121 of air can ever reach the nerve of the ear with the crude intensity (if I may use the expression) with which it is generated. Passing over preliminary apparatus, by which the vibrations122 of air are first collected, the impressions of sound are first received on the parchment of a little drum, which parchment can be relaxed or tightened123 with the quickness of thought, so as to modify the force of the139 impression. This impression is then, by means of a little chain of bones, conveyed across the drum, which is filled with air. It then reaches a portion of the ear in which are found very curious cavities and canals, of various forms, and taking different directions, and which, from the curious and complex arrangement of the whole, is not inappropriately called the labyrinth124. This is the mysterious seat of those nerves which convey impressions to the brain. There is, however, here, an arrangement more exquisite than any we have yet mentioned.
In these cavities and canals, which are themselves so small as to be not unfit objects for magnifying glasses, there are corresponding delicate sacs and tubes, and these are filled with a limpid125 fluid. On this delicate apparatus, so exquisitely126 calculated to modify any undue127 force of impression, the sensitive extremities128 of the auditory nerves are spread out, which convey impressions to the brain. We see, therefore, how carefully these portals of the body are guarded; arrangements equally conservative prevail throughout. We might show a similarly exquisite arrangement in the laws governing the mind; but that is not our present object. We have seen hitherto that, beautiful as the arrangement is for securing us against painful impressions, it has been in a great degree mechanical.
The stomach, however, is the portal to a vast series of important organs, and is protected by a phalanx of sentinels, endowed with powers proportioned to the importance of the organ which they guard. There is little that falls within any idea which we can express by the term mechanical; everything is subjected to an examination essentially sentient129; to powers residing in the nerves; the laws and operations of which, we can with proper attention trace out, but which exhibit powers demonstrative of an intensity and refinement130 of which our limited perceptions scarcely enable us to form a definite idea.
First, there is the olfactory131 nerve, between which and the stomach there is the most vivid sympathy.
Until our tastes become vitiated, the stomach seldom admits anything of which the nose reports unfavourably. The sense of smell, even in the somewhat measured power possessed132 by man,140 is capable of detecting forms of matter so subtle as to be beyond our powers of imagination. Nothing which so plainly deals with "matter" impresses more strongly the immense range which must exist between the chemistry of life and that of the laboratory. We all know the extraordinary powers of musk133. I have myself a small mass of odorous matter (a Goa ball) which, from the circumstances under which it came into my possession, must have been emitting the odour for little less than a century. It has been exposed to air, is covered by a film of gold (I believe), is in no respect visibly changed, and for the last thirty years not detectably in weight; yet at this moment it emits as strong an odour of musk as ever. How exquisitely subtle must be the matter thus emitted; or how still more wonderful if it merely so modifies the atoms of air in its neighbourhood as to produce odour. We have no intellectual powers which enable us to realize a conception of such infinite tenuity of matter; yet the sense of smell instantly detects its presence.
Next come the nerves of the tongue; and here again, in natural conditions, there is a constant harmony between them and the stomach—that to which the taste readily gives admission being, in undisturbed conditions of the economy, some guarantee that it is innoxious; but what these functions are to the stomach, the stomach is to the other organs. In the first place, in natural conditions it usually at once rejects any noxious134 material which, from being disguised, or from any other circumstances, may have eluded135 the vigilance of the sentinels I have mentioned; but it has a vivid sympathy with every organ in the body. If anything deleterious be once admitted, it has to go through various processes, which may render it a source of indefinite disturbance; therefore, if any organ in the series of the blood-manufacture be materially disturbed—that is, so as to be disabled—the stomach usually refuses food; because there is no other way of stopping the mischief137. Illustrations of this occur in many disorders of the kidney, in many affections of the alimentary canal, as also of the liver, and other parts.
No doubt the stomach is therefore a most important organ; but to suppose that it is therefore always the seat of disorder, is141 not only a most mischievous error, but a complete blind to its most beautiful and instructive relations; and as opposite to Mr. Abernethy's views as the most narrow can be to the most comprehensive. Proceeding138 with his illustrations, Mr. Abernethy cites a number of most instructive cases, such as palsy and other affections of most serious character, which too often result either from organic disease of some organ, or from mechanical pressure on the brain or spinal139 marrow140, but which in the cases cited depend on disorder of the digestive organs.
It is impossible to exaggerate the interest or importance of these cases; not only from the fact that they almost certainly would have led to organic disease, but also for the value of that practical discrimination which they exemplify. Again, the very treatment which would have been proper, which had sometimes been begun, and which was not inappropriate to cases of organic disease, with which the symptoms were in part identical, would have inevitably141, in the cases in question, only served to exasperate142 the very conditions they were designed to relieve, and to hasten those processes against which they were intended to guard.
No one can understand the force of these cases, without recollecting143 the intense difficulty of ascertaining144 that point at which disorder ceases to be merely functional145, and at which organic disease begins. This is of all things the most difficult to determine in the whole circle of physiological or pathological inquiry.
The symptoms alone are absolutely useless in any case of real difficulty. Of that Abernethy was well aware, and he did much to guard us against the error into which a reliance on them was calculated to lead. He knew that organs which were diseased would sometimes afford indications not distinguishable from those of health; and that, conversely, organs essentially sound would sometimes only afford those signs which were indicative of disorder. We have, we trust, made some little progress in this very difficult branch of inquiry; and although it is true that organic disease not unfrequently escapes detection during life, yet, so far as we have observed, it is only in those cases in which there is, notwithstanding the daily lessons of experience, an142 improper146 reliance on what are called the symptoms. We assert, without the least hesitation147, that organic diseases should seldom elude136 detection where the investigation is sufficiently comprehensive; but it must include all the facts of the case, the early history, and such circumstances which, however remote, have been over and over again proved to be capable of exerting an influence on the body; an investigation which, however vainly pleaded for in medical science, however regarded as too exacting148, involves nothing more in principle than is required as a matter of course in all other scientific investigations.
When these conditions are observed, it is very rarely that we cannot detect organic affections in organs in which there may be no present symptoms. In relation to the extent to which they may be affected, it is true we have yet much to learn; still, if cases be judged of not by the history merely, nor by the symptoms merely, but by both in conjunction, and if to these be added a careful observation of the amount of work that the organs are separately or collectively doing, as compared with their natural proportions; together with a careful estimate of that which the actions of any visible disease may be eliminating from the body; then, indeed, we have good ground for hope that means will be opened to us of distinguishing more accurately149 various states of the system; and additional principles and powers disclosed of readjusting the disturbed balance of the various functions, which is the essential element of disease.
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antiquity
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| n.古老；高龄；古物，古迹 | |
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celestial
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| adj.天体的；天上的 | |
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transparent
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| adj.明显的，无疑的；透明的 | |
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fully
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| adv.完全地，全部地，彻底地；充分地 | |
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prevailing
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| adj.盛行的；占优势的；主要的 | |
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emphatic
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| adj.强调的，着重的；无可置疑的，明显的 | |
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forth
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| adv.向前；向外，往外 | |
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sufficiently
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| adv.足够地，充分地 | |
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detailed
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| adj.详细的，详尽的，极注意细节的，完全的 | |
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10
entirely
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| ad.全部地，完整地；完全地，彻底地 | |
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11
nay
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| adv.不；n.反对票，投反对票者 | |
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12
demonstration
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| n.表明，示范，论证，示威 | |
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13
surgical
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| adj.外科的，外科医生的，手术上的 | |
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14
astonishment
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| n.惊奇，惊异 | |
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15
exquisite
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| adj.精美的；敏锐的；剧烈的，感觉强烈的 | |
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16
simplicity
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| n.简单，简易；朴素；直率，单纯 | |
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17
peculiar
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| adj.古怪的，异常的；特殊的，特有的 | |
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18
analytical
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| adj.分析的；用分析法的 | |
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19
enthusiast
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| n.热心人，热衷者 | |
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20
interpretation
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| n.解释，说明，描述；艺术处理 | |
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21
obedience
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| n.服从，顺从 | |
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22
disturbance
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| n.动乱，骚动；打扰，干扰；(身心)失调 | |
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23
manifestations
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| n.表示，显示（manifestation的复数形式） | |
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24
remarkable
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| adj.显著的，异常的，非凡的，值得注意的 | |
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25
truthfulness
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| n. 符合实际 | |
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26
truthful
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| adj.真实的，说实话的，诚实的 | |
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27
impede
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| v.妨碍，阻碍，阻止 | |
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28
inadequate
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| adj.(for,to)不充足的，不适当的 | |
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29
distinguished
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| adj.卓越的，杰出的，著名的 | |
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30
pervading
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| v.遍及，弥漫( pervade的现在分词 ) | |
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31
onward
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| adj.向前的，前进的；adv.向前，前进，在先 | |
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32
drawn
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| v.拖，拉，拔出；adj.憔悴的，紧张的 | |
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33
wrests
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| （用力）拧( wrest的第三人称单数 )； 费力取得； （从…）攫取； （ 从… ） 强行取去… | |
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34
legitimately
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| ad.合法地；正当地，合理地 | |
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35
virtue
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| n.德行，美德；贞操；优点；功效，效力 | |
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36
philosophical
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|
| adj.哲学家的，哲学上的，达观的 | |
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37
inquiries
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| n.调查( inquiry的名词复数 )；疑问；探究；打听 | |
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38
inquiry
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| n.打听，询问，调查，查问 | |
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39
anatomy
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|
| n.解剖学，解剖；功能，结构，组织 | |
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40
investigation
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| n.调查，调查研究 | |
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41
phenomena
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| n.现象 | |
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42
physiology
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| n.生理学，生理机能 | |
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43
essentially
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| adv.本质上，实质上，基本上 | |
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44
juxtaposition
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| n.毗邻，并置，并列 | |
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45
circumspection
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|
| n.细心，慎重 | |
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46
watchful
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|
| adj.注意的，警惕的 | |
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47
disturbances
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|
| n.骚乱( disturbance的名词复数 )；打扰；困扰；障碍 | |
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48
annoyance
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|
| n.恼怒，生气，烦恼 | |
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49
auspiciously
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|
| adv.吉利； 繁荣昌盛； 前途顺利； 吉祥 | |
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50
affected
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| adj.不自然的，假装的 | |
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51
instinctive
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|
| adj.(出于)本能的；直觉的；(出于)天性的 | |
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52
excellence
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|
| n.优秀，杰出，(pl.)优点，美德 | |
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53
thoroughly
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|
| adv.完全地，彻底地，十足地 | |
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54
investigations
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|
| （正式的）调查( investigation的名词复数 )； 侦查； 科学研究； 学术研究 | |
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55
concurrent
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|
| adj.同时发生的，一致的 | |
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56
physiological
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|
| adj.生理学的，生理学上的 | |
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57
pointed
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| adj.尖的，直截了当的 | |
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58
stimulus
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| n.刺激，刺激物，促进因素，引起兴奋的事物 | |
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59
exertions
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| n.努力( exertion的名词复数 )；费力；（能力、权力等的）运用；行使 | |
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60
deranged
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| adj.疯狂的 | |
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61
derange
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| v.使精神错乱 | |
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62
previously
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| adv.以前，先前（地） | |
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63
assails
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|
| v.攻击( assail的第三人称单数 )；困扰；质问；毅然应对 | |
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64
mischievous
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|
| adj.调皮的，恶作剧的，有害的，伤人的 | |
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65
practitioners
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| n.习艺者，实习者( practitioner的名词复数 )；从业者（尤指医师） | |
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66
allotted
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| 分配，拨给，摊派( allot的过去式和过去分词 ) | |
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67
recondite
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|
| adj.深奥的，难解的 | |
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68
interfering
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|
| adj. 妨碍的 动词interfere的现在分词 | |
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69
investigators
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|
| n.调查者，审查者( investigator的名词复数 ) | |
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70
considerably
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|
| adv.极大地；相当大地；在很大程度上 | |
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71
disorder
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|
| n.紊乱，混乱；骚动，骚乱；疾病，失调 | |
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72
expressive
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|
| adj.表现的，表达…的，富于表情的 | |
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73
mischievously
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|
| adv.有害地；淘气地 | |
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74
illustrate
|
|
| v.举例说明，阐明；图解，加插图 | |
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75
bruise
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|
| n.青肿，挫伤；伤痕；vt.打青；挫伤 | |
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76
interfered
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|
| v.干预( interfere的过去式和过去分词 )；调停；妨碍；干涉 | |
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77
entity
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|
| n.实体，独立存在体，实际存在物 | |
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78
ascertainment
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|
| n.探查，发现，确认 | |
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79
entail
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|
| vt.使承担，使成为必要，需要 | |
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80
defective
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|
| adj.有毛病的，有问题的，有瑕疵的 | |
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81
inflamed
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|
| adj.发炎的，红肿的v.（使）变红，发怒，过热( inflame的过去式和过去分词 ) | |
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82
pneumonia
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| n.肺炎 | |
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83
malady
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|
| n.病，疾病(通常做比喻) | |
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84
lamentably
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|
| adv.哀伤地，拙劣地 | |
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85
applied
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|
| adj.应用的；v.应用，适用 | |
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86
mere
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|
| adj.纯粹的；仅仅，只不过 | |
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87
judiciously
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|
| adv.明断地，明智而审慎地 | |
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88
amplify
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|
| vt.放大，增强；详述，详加解说 | |
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89
testimony
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|
| n.证词；见证，证明 | |
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90
delineation
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|
| n.记述；描写 | |
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91
disorders
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|
| n.混乱( disorder的名词复数 )；凌乱；骚乱；（身心、机能）失调 | |
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92
remarkably
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| ad.不同寻常地，相当地 | |
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93
intelligible
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|
| adj.可理解的，明白易懂的，清楚的 | |
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94
interspersed
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|
| adj.[医]散开的；点缀的v.intersperse的过去式和过去分词 | |
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95
confirmation
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|
| n.证实，确认，批准 | |
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96
civilized
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| a.有教养的，文雅的 | |
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97
curry
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|
| n.咖哩粉，咖哩饭菜；v.用咖哩粉调味，用马栉梳，制革 | |
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98
painstaking
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|
| adj.苦干的；艰苦的，费力的，刻苦的 | |
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99
penetrating
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|
| adj.（声音）响亮的，尖锐的adj.（气味）刺激的adj.（思想）敏锐的，有洞察力的 | |
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100
acting
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| n.演戏，行为，假装；adj.代理的，临时的，演出用的 | |
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101
specially
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|
| adv.特定地；特殊地；明确地 | |
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102
alimentary
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|
| adj.饮食的，营养的 | |
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103
alluded
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| 提及，暗指( allude的过去式和过去分词 ) | |
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104
derivable
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| adj.可引出的，可推论的，可诱导的 | |
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105
tranquillity
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| n. 平静, 安静 | |
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106
digestion
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| n.消化，吸收 | |
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107
auxiliaries
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| n.助动词 ( auxiliary的名词复数 )；辅助工，辅助人员 | |
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108
apparatus
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| n.装置，器械；器具，设备 | |
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109
machinery
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| n.(总称)机械，机器；机构 | |
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110
rejection
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| n.拒绝，被拒，抛弃，被弃 | |
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111
derangement
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| n.精神错乱 | |
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112
homely
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| adj.家常的，简朴的；不漂亮的 | |
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113
vigilant
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| adj.警觉的，警戒的，警惕的 | |
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114
abrupt
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| adj.突然的，意外的；唐突的，鲁莽的 | |
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115
intensity
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| n.强烈，剧烈；强度；烈度 | |
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116
aperture
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| n.孔，隙，窄的缺口 | |
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117
vividly
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| adv.清楚地，鲜明地，生动地 | |
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118
densities
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|
| 密集( density的名词复数 )； 稠密； 密度（固体、液体或气体单位体积的质量）； 密度（磁盘存贮数据的可用空间） | |
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119
velocity
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| n.速度，速率 | |
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120
retardation
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| n.智力迟钝，精神发育迟缓 | |
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121
vibration
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| n.颤动，振动；摆动 | |
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122
vibrations
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| n.摆动( vibration的名词复数 )；震动；感受；（偏离平衡位置的）一次性往复振动 | |
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123
tightened
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| 收紧( tighten的过去式和过去分词 )； （使）变紧； （使）绷紧； 加紧 | |
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124
labyrinth
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|
| n.迷宫；难解的事物；迷路 | |
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125
limpid
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| adj.清澈的，透明的 | |
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126
exquisitely
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| adv.精致地；强烈地；剧烈地；异常地 | |
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127
undue
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|
| adj.过分的；不适当的；未到期的 | |
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128
extremities
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|
| n.端点( extremity的名词复数 )；尽头；手和足；极窘迫的境地 | |
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129
sentient
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| adj.有知觉的，知悉的；adv.有感觉能力地 | |
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130
refinement
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| n.文雅；高尚；精美；精制；精炼 | |
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131
olfactory
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| adj.嗅觉的 | |
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132
possessed
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| adj.疯狂的；拥有的，占有的 | |
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133
musk
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| n.麝香, 能发出麝香的各种各样的植物，香猫 | |
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134
noxious
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| adj.有害的，有毒的；使道德败坏的，讨厌的 | |
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135
eluded
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|
| v.（尤指机敏地）避开( elude的过去式和过去分词 )；逃避；躲避；使达不到 | |
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136
elude
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| v.躲避，困惑 | |
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137
mischief
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|
| n.损害，伤害，危害；恶作剧，捣蛋，胡闹 | |
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138
proceeding
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| n.行动，进行，(pl.)会议录，学报 | |
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139
spinal
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|
| adj.针的，尖刺的，尖刺状突起的；adj.脊骨的，脊髓的 | |
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140
marrow
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|
| n.骨髓；精华；活力 | |
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141
inevitably
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| adv.不可避免地；必然发生地 | |
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142
exasperate
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| v.激怒，使（疾病）加剧，使恶化 | |
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143
recollecting
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| v.记起，想起( recollect的现在分词 ) | |
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144
ascertaining
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| v.弄清，确定，查明( ascertain的现在分词 ) | |
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145
functional
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| adj.为实用而设计的，具备功能的，起作用的 | |
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146
improper
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| adj.不适当的，不合适的，不正确的，不合礼仪的 | |
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147
hesitation
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| n.犹豫，踌躇 | |
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148
exacting
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| adj.苛求的，要求严格的 | |
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149
accurately
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| adv.准确地，精确地 | |
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