PART FIRST. (continued 3)

32. As the human body is thus furnished with an apparatus for separating and carrying off, it is also furnished with one for absorbing or taking in. All the inward parts of the body are moist; and the moisture is furnished by the small vessels above described, and which separate part of the lymph from the blood. By such continual separation the cavities of the belly, breast, brain, &c. would soon be filled with liquid, were not some means provided for carrying it off as fast as it is formed. The means in question are a set of small vessels called lymphatics. These “arise from the internal surface of the breast, belly, and every cavity of the body; they also overspread the whole external surface of the body, and large lymphatic vessels are usually found close to the large blood vessels of the extremities, besides those small superficial ones which lie above the muscles in the cellular membrane (the fat or rather the membrane containing it.) The large viscera generally have two sets of lymphatics, one lying on the surface of the viscus, and the other accompanying the blood vessels belonging to it. The faculty of absorption, though refused to the lymphatics, was ascribed by many anatomists to common veins, and this opinion continued to prevail in some degree, until Hunter and Monro totally overturned it, exploding at the same time the notion that any of the lymphatics are continuations of arteries, and establishing, beyond a doubt, that all are absorbent vessels.”54 All the lymphatics terminate in the thoracic duct; so that the liquid separated by the exhalant arteries (so the vessels are termed by which that fluid is separated) is again mixed with the blood, and again performs the same offices.

We have now taken a review of the several parts of the human body, slight and superficial indeed, but such as the limits of this work would allow, and sufficient to furnish to those entirely unacquainted with medical matters some general ideas on the subject. We have seen that the body, in general, consists principally of four great parts, the blood-vessels, the lymphatic vessels, the nerves, and the muscles. Besides these we enumerate the glands and membranes; the former being nearly allied to the blood-vessels, the latter apparently to the nerves. The bones, having no concern with our present inquiry, are not taken notice of. The stomach and intestines, being principally composed of muscular fibres, nerves, and blood-vessels, must be considered as belonging to these departments. Each of these large divisions has obtained the name of system; and even the subdivision of the blood-vessels into arteries and veins. Thus the arteries of the body, taken collectively, are called the arterial system; the veins the venous system; the brain and nerves the nervous system; the muscles the muscular system; the lymphatics the lymphatic system; and the glands the glandular system; &c. These appellations have been given for the sake of distinctness and perspicuity, but they have had a bad tendency. Insignificant disputes have arisen concerning the superiority of one system to the other, and which is to be accounted the primum mobile of the body. By observing also the general structure of the body in a more full and ample manner than that of the parts which compose it, physicians have been apt to generalize too much in their theories, and to fancy that from a few obvious laws they might be able to explain the phenomena of disease in almost every possible variety. To illustrate this, let us take the blood for an example. This to sight appears an homogeneous fluid; and Boerhaave and others have ascribed diseases to some defect or bad quality of the blood. But this fluid consists of three parts, each, as far as we can perceive, essentially distinct from the other; viz. the lymph, serum, and red globules. As each of these happens to be diseased, the cure must be different; or if two happen to be diseased, the medicines must still be varied. But, besides these general diseases arising from what, like the blood, is common to the whole body, each component part of the body has an arterial system, a venous system, a nervous and lymphatic system, &c. belonging to itself; all of which, though dependent on the body at large, have yet laws of their own, in consequence of which any one of them may be considerably diseased without much affecting the general system; and this constitutes what is called local disease. Again: The parts of the body are so connected with one another, that the disease of one may show itself in another; or it may affect the whole body in such a manner as to produce a general disease; though Dr. Rush considers this last, at least from injuries of the viscera, as a rare occurrence;55 but we certainly know that general diseases are very often followed by evident diseases of particular organs; and in these cases it is impossible to say whether the general disease did not begin, though imperceptible to us, in that very organ in which we suppose it to terminate when the local disease was come to such an height as to be evident to our senses. In some cases it is plain that local injuries will bring on most violent diseases of the whole system. Thus a local inflammation of the end of one of the fingers, by physicians called a paronychia, has been known to induce a most violent fever, nay, even to occasion death. These violent symptoms end as soon as the suppuration is completed; so that, were it not for the excessive pain of the inflammation, we might be apt to suppose that the fever terminated in the suppuration, whereas it evidently was occasioned by the local disease, or the tendency of the part to suppurate; the pain and inflammation being necessary preliminaries. Again: When an intermittent fever is said to terminate, or to be followed, by a hardness of the liver, we do not certainly know whether an original disease of the liver might not have been the cause of the intermittent. From a consideration of all these things, viz. the extreme diversity of parts which compose the human body, the ultimate invisibility of the structure of each, the incomprehensible manner in which they are united, the equally incomprehensible dependence they have upon one another in some cases, and independence in others, the numerous laws by which they are governed, and which must be very much unknown to us, the invisible and incomprehensible nature of the powers which act upon them, &c. &c. I say, when we consider all these things, the boldest theorist must be humbled when he attempts to account for the phenomena of disease in any one instance. The excessive difficulty in which we are involved is beautifully described by Dr. Ferriar when speaking of hysterics; and obstacles equally insuperable by our theories will undoubtedly be met with in any other distemper. “We are ignorant (says he) by what laws the body possesses a power of representing the most hazardous disorders, without incurring danger; of counterfeiting the greatest derangement in the circulating system, without materially altering its movements; of producing madness, conscious of its extravagances; and of increasing the acuteness of sensation by oppressing the common sensorium. In hysterical affections all these appearances are excited, which are incompatible with the reasonings of every system-maker who has yet endeavoured to explain the inexplicable. Nature, as if in ridicule of the attempts to unmask her, has, in this class of diseases, reconciled contradictions, and realized improbabilities, with a mysterious versatility, which inspires the true philosopher with diffidence, and reduces the systematic to despair.”

Notwithstanding all these difficulties, however, physicians have theorised, and that with such animosity, as if all the arcana of nature had been laid open to every professor who thought proper to invent or new-model a system; though the constant succession of theories might certainly have shown them the vanity of such attempts. Some of these we must now consider.

Medical theorists have exerted their greatest abilities in explaining the nature of those general diseases affecting the whole body, denominated fevers; and which are likewise called acute diseases, from the violence with which they sometimes attack, and the rapidity with which they run through their course. Dr. Fordyce says, that fever will sometimes kill in five minutes from the first sensation of uneasiness. Ancient physicians have described a number of fevers, which they supposed to be of different species, and accordingly have distinguished by different names. Modern system-makers have added to the number; so that a bare detail of the names which they have given to their divisions and subdivisions, would constitute a very formidable catalogue; but the latest practitioners are decidedly of opinion that there is but one kind of fever, varying itself according to circumstances. Dr. Rush declares himself of this opinion in the most express and positive terms. “There is (says he) but one fever. However different the predisposing, remote or exciting causes may be, . . . still, I repeat, there can be but one fever. . . . Thus fire is an unit, whether it be produced by friction, percussion, electricity, fermentation, or by a piece of wood or coal in a state of inflammation.”56

“I have said that there is but one fever. Of course I do not admit of its artificial division into genera and species; a disease which so frequently changes its form and place, should never have been designated, like plants and animals, by unchangeable characters. . . . Much mischief has been done by nosological arrangements of diseases. They erect imaginary boundaries between things which are of an homogeneous nature. . . . They gratify indolence in a physician, by fixing his attention upon the name of a disease, and thereby leading him to neglect the varying state of the system, &c.”57

So much then having been said and written upon the disease in question, one might be apt to suppose that the nature of fever would have been thoroughly investigated, and its causes explained in the most satisfactory manner, long before this time. Instead of this, however, we find it still like a word which every body uses, and nobody understands. Dr. Fordyce, who has lately written a treatise on the subject, endeavours to prove that there is not any single symptom from the existence of which we can certainly determine the presence of this disease. “Fever (says he) has obtained its name in Greek, Latin, Arabic and Persian, principally from the idea of heat: pur, in Greek fire; febris in Latin, from fervere, to burn,” &c. This idea, he goes on to demonstrate, is erroneous; as the body of a feverish patient frequently sinks the thermometer below the natural standard; while the patient sometimes finds himself cold when the thermometer shows him to be really hot, and hot while the same instrument shows him to be cold. Neither is cold, followed by heat, a certain indication of the presence of fever, as many fevers begin without any previous sensation of cold. Frequency of the pulse also is no certain sign; and having discussed this last symptom he concludes thus. “If we examine the restlessness, anxiety, state of the tongue, head-ach, or any other of the symptoms which often take place in fever, we shall find that they also may be present when there is no fever, and absent in a patient afflicted with this disease; and therefore we cannot allow that there is any pathognomic symptom of fever.”58 Dr. Rush declines giving any definition of fever;59 but, with all due deference to these two very experienced physicians, we must account such extreme scepticism altogether erroneous. If fever cannot be defined, it cannot be described; for a definition is no other than a short description. If again there be no single symptom by which the presence of fever can be known, it is impossible that there can be any combination by which it can be known, any more than we can form an unit by any combination of cyphers. In fact Dr. Fordyce himself is at last obliged to acknowledge that there is a certain symptom with which fever generally begins; and, by his insisting upon it in various parts of the work, we must certainly be induced to suppose that it was by this sign principally that he determined whether his patients had a fever or not. “The first appearance (says he) which generally takes place is uneasiness and restlessness; a general uneasiness, the patient feeling himself ill, but incapable of fixing on any particular part of the body. This uneasiness affects the mind at the same time. Perhaps in this case it is the mind that is first affected. . . . Along with this uneasiness there is a restlessness, the patient wishing to change his place or posture frequently; the mind cannot likewise rest upon one object; it often wanders from one to another subject. At the same time there is a feel of weariness which resists the disposition in the patient to change his place and posture, and resists the disposition of the mind to alter the object of its attention, rendering the wish for such changes ineffectual. With these arises an actual inability of exerting the muscular powers, or performing any of the functions of the body; and also an actual inability of exercising the great faculties of the mind, the powers of perception, memory, arrangement of ideas, and of the judgment, in the same degree that they existed in health. The degree in which these take place is extremely different in the attacks of different fevers; but these appearances are very rarely absent, although indeed they may also happen in other diseases.”

Dr. Rush accounts the lassitude with which fever begins, one of the transient phenomena of it; and this with other phenomena he calls symptoms. Such as are more permanent and fixed, and which by other writers have been reckoned different species, he calls states; and of these he enumerates forty. Such as have any relation to the plague are as follow.

I. The MALIGNANT state, known by attacking frequently without a chilly fit, is attended with coma, a depressed, slow or intermitting pulse, and sometimes by a natural temperature or coldness of the skin. . . . This depressed state of fever more frequently when left to itself terminates in petechiæ, buboes, carbuncles, abscesses and mortifications, according as the serum, lymph, or red blood, is effused in the viscera or external parts of the body.

2. The SYNOCHA, or common inflammatory state; attacking suddenly with chills, succeeded by a quick, frequent and tense pulse, great heat, thirst, and pains in the bones, joints, breast or sides.

3. The BILIOUS state of fever; known by a full, quick and tense pulse, or by a quick, full and round pulse without tension, and by a discharge of green, dark coloured or black bile from the stomach and bowels. This state sometimes assumes the form of an hectic; the patient feels no pain in his head, has a tolerable appetite, and is even able to sit up and do business.

4. The TYPHUS state; known by a weak and frequent pulse, a disposition to sleep, a torpor of the alimentary canal, tremors of the hands, a dry tongue, and, in some instances, a diarrhœa. Sometimes it assumes symptoms of synocha on the eleventh, fourteenth, and even twentieth days. The common name of this state is the nervous fever.

5. Intermissions, or the INTERMITTING and REMITTING states, occur most distinctly and universally in those which partake of the bilious diathesis.

6. The SWEATING state occurs not only in the plague, but in the yellow fever, small pox, pleurisy, rheumatism, hectic and intermitting states.

7. The FAINTING state; occurring in the plague, yellow fever, small pox, and some states of pleurisy.

8. The BURNING state. This is attended not only with an intolerable sensation of heat in the bowels, but with a burning sensation excited in those who touch the patient’s skin. It occurs mostly in the remitting fevers of Asia.

9. The CHILLY state differs from a common chilly fit by continuing four or five days, and to such a degree that the patient frequently cannot bear his arms out of bed. The coldness is most obstinate in the hands and feet. A coolness only of the skin attends in some cases, which is frequently mistaken for an absence of fever.

10. The INTESTINAL state; including the cholera morbus, diarrhœa, and cholic.

11, 12, 13, 14, 15. The APOPLECTIC, PHRENETIC, PARALYTIC, LETHARGIC and VERTIGINOUS states.

16. The ERUPTIVE state; including the small pox, measles, and other exanthemata of Dr. Cullen.

17. The HÆMORRHAGIC state; known by fluxes of blood from various parts of the body.

18. The CONVULSIVE or SPASMODIC state. Convulsions are frequently attendant on the malignant state of fever.

19. The CUTANEOUS state; attended with various eruptions on the skin, particularly petechiæ.

These include the most remarkable varieties described by physicians as different species. From the subsequent account of the symptoms of the plague, it will appear that this single distemper monopolises, as it were, the symptoms, at least the most dangerous and terrible, belonging to them all. Those nosologists therefore who suppose the states of fever above described to be different species, instead of saying that the plague belongs to one kind of fever, ought to say that it is a complication of a great many different kinds. But here a question arises: Do all the varieties of fever just now described, or do all the other fevers described by different authors, include all the different modes by which the plague makes its attack? If so, then we know that the plague really partakes of the nature of fever, or may be accounted the highest degree of it. This is the opinion of Dr. Rush; for in his 4th vol. p. 153, he considers the different inflammatory states of fever, according to their strength, in the following order. 1. The plague. 2. The yellow fever. 3. The natural small pox. 4. The malignant sore throat, &c. To this I can have but one objection, and to me it appears insuperable; viz. that the plague frequently destroys without any symptom of fever; and, if so, we must certainly account it a distemper of another kind. To decide this matter, let us compare the symptoms of the most violent fever with what happens in times of violent pestilence. We can scarce imagine a fever more powerful than that which destroys in five minutes, and the following is the description of it from Dr. Fordyce. “When the first attack of fever has been fatal, it has been classed among sudden deaths, and all of these have been very erroneously called apoplexy, or syncopy (fainting.). . . . When the attack is fatal, it sometimes kills in five minutes, sometimes it requires half an hour, seldom longer than that time. While the patient is yet sensible, violent head-ach with a great sense of a chilliness takes place, the extremities become very cold, and perfectly insensible; there is great prostration of strength, so that the patient is incapable of supporting himself in an erect posture; he becomes pale, his skin is of a dirty brown, and he is soon insensible to external objects; the eyes are half-open, and the cornea somewhat contracted. If the patient goes off very soon, the pulse is diminished, and at last lost, without any frequency taking place, but if it be longer before he dies, the pulse becomes excessively small and frequent; all the appearances of life gradually subside, and the patient is carried off. Of this the author has seen instances, sometimes at the first attack, oftener in the returns of the disease, although very few.”

This no doubt is very terrible, and no plague whatever can exceed it. Indeed, when death is the termination, it signifies little what the disease is called. But the question is not whether fever or plague is the most dreadful, but whether they are the same. Now, from the above description, it is plain that fever never kills without some warning. In the present instance, head-ach and chilliness give a certain, though short, warning of the ensuing catastrophe; but, in violent plagues, Dr. Sydenham informs us, that people have been suddenly destroyed as if by lightning. Dr. Guthrie assures us that in the last plague at Moscow he has seen soldiers drop down suddenly as if they had been struck by lightning, or by a musket ball; yet some of these recovered by bleeding and proper management; but it is certainly not unreasonable to suppose that many, who were not thus taken care of, perished. Dr. Hodges speaks of the contagion of the plague in the most energetic terms. He says, “it is so rare, subtile, volatile and fine, that it insinuates into, and resides in, the very pores and interstices of the aerial particles. It is said to be of a poisonous nature also, from its similitude to the nature of a poison, so that they seem to differ in degree only; for the deadly quality of a pestilence vastly exceeds either the arsenical minerals, the most poisonous animals or insects, or the killing vegetables; nay, the pestilence seems to be a composition of all the other poisons together, as well as in its fatal efficacies to excel them. . . . The contagion of the plague is more active than lightning, and in the twinkling of an eye carries to a distance putrefaction, mortification and death. As for the manner whereby it kills, its approaches are generally so secret, that persons seized with it seem to be fallen into an ambuscade or a snare, of which there seems to be no suspicion. . . . In the plague of 1665, as in many others, people frequently died without any symptoms of horror, thirst, or concomitant fever. A woman, who was the only one left alive of a family, and in her own opinion in perfect health, perceived upon her breast the pestilential spots, which she looked upon to be the fatal tokens; and in a very short space died, without feeling any other disorder, or forerunner of death. . . . A youth of a good constitution, after he had found himself suddenly marked with the tokens, believed at first that they were not the genuine marks, because he found himself so well; yet he was dead in less than four hours, as his physician had prognosticated. A fever, however, did for the most part show itself, and was always of the worst kind. Sometimes it seemed to resemble a quoridian, sometimes a tertian; there never was a total cessation, but every exacerbation was worse than before.” In like manner the author of the Journal of the Plague Year informs us that many, supposing themselves, and supposed by others, to be in good health, would suddenly find themselves seized with great sickness, crawl to a bench, and instantly expire. “Many (says Dr. Hodges) in the middle of their employ, with their friends and other engagements, would suddenly fall into profound, and often deadly sleeps.”

It is needless to multiply examples: the above are sufficient to show that the plague, when in its most violent state, kills suddenly and imperceptibly, and that like the bite of a vampire,60 without producing any sensible disorder. In a state somewhat inferior, it excites the most malignant fevers; in one still inferior it produces fevers of a milder nature, and so on until we find it so mild, that those infected with it are not even confined to their bed. In all this inquiry, however, we find the secrecy and invisibility of the pestilence, so often mentioned in scripture, still confirmed. Other distempers may “waste openly at noon-day,” but this always “walks in darkness.”

In one of the inferior stages of this distemper the body is affected with those eruptions named buboes and carbuncles. Dr. Patrick Russel, in his treatise on the plague at Aleppo, divides the symptoms of the distemper into six classes. In the first there were no eruptions, and all the patients of this class died. In the second, and all the rest, there were buboes and carbuncles. But, in the latter of these especially, it is worthy of remark, that they appear neither as a suppuration, nor as a common mortification, but like the eschar formed by a caustic, which can scarcely be cut by a knife. This appearance is not to be met with in any other disease. In many there are mortifications of various parts of the body, but all these are soft, and seemingly corruptions of the flesh. When a person dies of any ordinary distemper, the flesh soon corrupts and dissolves, but there is no example of its turning to a hard eschar like that made by a hot iron, or the caustic with which issues are made. This shews not merely a cessation of life, but the operation of some very active power in the body, like fire, tending to destroy the texture of it entirely, and to reduce it to a cinder. This power seems also to operate internally in the fleshy parts; for when the bodies of those were opened who died with the tokens, as they are called by Dr. Hodges, upon them, the mortification was always found much larger inwardly than it appeared to be on the outside. The tokens themselves are by Dr. Hodges called “minute distinct biasts, which had their origin from within, and rose up in little pyramidal protuberances, sometimes as small as pins’ heads, at others as large as a silver penny; having the pestilential poison chiefly collected at their bases,” &c.

That the plague was by the ancients reckoned a disease of a nature different from all others, appears from Galen, as quoted by Deusingius. “What is called the pestilence is most properly remarked by Galen not to be a genus of any known disease. For whatever diseases and symptoms are associated with the plague, truly and properly so called, the same are wont to be called pestilential diseases; of which indeed there are an innumerable multitude, and these not always nor every where the same.”61

In like manner Diemerbroeck, as quoted by Allen, gives his opinion, that “The plague is something different from a fever, and a fever is only a symptom of it, as I have very often observed; and therefore some very ill define the plague by a fever, since a fever does not essentially belong to it. . . . A pestilential fever, the companion of the plague, is not occasioned by a pestilential venom, but by the mediation of putrefaction; that is, it is not produced because the humours are infected with the pestilent venom, but because the heart, being irritated, overwhelmed and much weakened by the pestilent venom, can neither duly digest and rarefy, nor govern and sufficiently discharge the infected humours; which for this reason putrefy and acquire a preternatural heat, and so excite a fever; which by reason of the foresaid secondary cause, is different and distinct from the plague, and a symptom of it. This is confirmed both by the maxims and authority of the ancients and moderns, as well as by practice, and evident examples.”

Thus it appears, both by fair reasoning by induction from facts, and from the authority of the greatest physicians, that the plague is certainly a disease by itself, and entirely distinct from all others. Hence it follows, that, though we could investigate the causes of fever in their utmost extent, we might still be ignorant of the true plague. That nothing, however, may be omitted, let us now consider what physicians have advanced on this subject, and what progress they have made in ascertaining the sources from whence so many direful calamities are derived.

In an inquiry of this kind, or indeed concerning any cause whatever, it is plain that the nature of the effect must be first understood. Fever then being an effect, we must begin with investigating its nature. But fever itself is only manifest by certain changes in the human body. Before we can investigate the nature of fever, therefore, we must investigate the human body, and that in a manner very different from what we did before. We must now consider the sources of life; in what manner the vital principle acts upon the body, and by what means its motions can be disturbed, or how they may be rectified when once disordered, &c. &c.

The systems of medicine before the time of Boerhaave are now so generally exploded, that it is needless to take any notice of them; and the reputation of Boerhaave himself in this way seems to be almost expiring. His doctrines, nevertheless, merit some attention, because he takes into account a principle overlooked by succeeding theorists, viz. the cohesion of the parts of the body. That he did so is evident, from his having written upon the diseases of a weak and lax fibre, and the diseases of a strong and rigid fibre. In other respects he followed in a great measure the mechanical physicians of the former century. He therefore took but little notice of the nervous system, as being less subject, or indeed to appearance not at all subject, to the known laws of mechanics. The blood was more manageable. The microscopical discoveries of Lewenhoeck furnished an excellent foundation for his system. This celebrated observer had discovered, or fancied he had discovered, that the red part of the blood is composed of globules. Inaccurate indeed these globules must have been, since each of them was composed of six; four touching one another in the middle, with one above, and one below, thus . The serum was said to be composed of single globules, and by this attenuation it was supposed that the fluid, instead of red, appeared of a yellow colour. Still, however, this was insufficient. Each of the yellow globules was discovered (either by fancied observations or by conjecture, it matters not which) to be composed of six others, which, singly taken, might constitute the lymph or some other fluid; and thus, like the number of the Beast, we might go on by sixes to the end of the chapter, and solve all the phenomena of nature. In justice to the microscopists, however, it must be observed, that some of them have given a much less fanciful account of the structure of the blood than Lewenhoeck. Mr. Hewson found it composed of vesicles, or small bladder-like substances, with a black spot in the middle. These vesicles dissolved in pure water, but kept their original form, which he says was as flat as a shilling, when a small portion of neutral salt was added to the fluid. The solid particles he supposed to be produced by the lymphatic system; the black particles by the spleen.

The supposed observations of Lewenhoeck were of considerable use to Boerhaave in the forming of his system of medicine, though they seem not to have accorded very well with his doctrine of lentor or viscidity in the blood. But, let this be as it will, having laid it down as the foundation of his theory, that the diseases of the body proceeded from too great a laxity of the fibres, or from too great a rigidity of them, and a great many from this lentor, his practice was accordingly directed to such medicines as he imagined would remove these supposed causes of disease. As the lentor of the blood was one of his favourite suppositions, he was therefore perpetually at war with this imaginary enemy, and dealt very much in saponaceous medicines with a view to break it down. But here it is evident that this great man was mistaken, even though we should allow the existence of lentor as much as he pleased. The viscidity, lentor, or any other state of the blood, is an effect of something. It is part of that state into which the body is brought by the disease. The efforts of the physician therefore ought to be against that which produces the lentor; for, unless this be done, the cause of the disease must perpetually counteract the medicines by producing new lentor as fast as they destroy it; and besides, must have greatly the advantage of the physician, by being already in possession of the whole mass of blood, while the medicines can only enter it very gradually, and that by the stomach and lacteals, instead of being instantly mixed with it, and exerting their power immediately upon the fluid itself.

But besides this mistake, which is common to other systems, Boerhaave’s lentor has been denied, and that upon such strong grounds that it is now universally exploded. Another system quickly succeeded, in which every thing was managed by the nerves. This was introduced by Hoffman, adopted, and perhaps improved, by Dr. Cullen, under whose auspices it acquired such a degree of celebrity, that for a long time it was dangerous to write or speak against it; and the person who had the audacity to do so underwent a kind of medical proscription from the Edinburgh College and all its students. According to this celebrated theorist, the brain is that part of the body first formed in the embryo; it may be seen with nerves proceeding; from it long before the heart or any blood-vessel belonging to it is visible. Hence we are to conclude that this part is necessary to the existence of every other part of the body, though it doth not appear that they are essentially necessary to its existence. The superiority of the nerves to all other parts being thus established, the Doctor undertook to prove that all other parts of the body were formed from them; that the body is nourished immediately from them, and in short that the whole body is in such subjection to the nervous system, that, except for the mere purpose of distending the vessels, we can scarcely know for what end the blood exists; since the nerves can alter its consistence, or that of any of the fluids secreted from it, by a mere affection of that system, without any thing either added to or taken from the vital fluid.

Thus we were compelled to believe that all diseases at their first origin are affections of the nervous system, from whence they are propagated through the whole body. The Cullenian practice in acute diseases, of which the plague is the most violent, was built upon a maxim of Hoffman: “Atonia gigoit spasmos:” Atony produces spasms. In explaining the nature of typhus fever, therefore, with which he classes the plague, the Doctor supposed that the contagion acted first upon the nervous system, by producing therein a debility. The immediate effect of this debility is a spasm, or preternatural contraction of the capillary vessels, or extremely small arteries. Hence the blood finds some difficulty in circulating, and the patient is seized with shivering, and has a sense of cold. When this has continued for some time the system begins to re-act against its enemy; the spasm is resolved, and, the reaction of the system continuing, the action of the heart and arteries is augmented, and the body becomes warmer.

Thus the coldness, shivering, and consequent heat, which constitute the first attack of fever, are very plausibly explained; but in the mode of cure this learned physician fell into the same mistake with Dr. Boerhaave; for though spasm is undoubtedly, even according to himself, an effect, he directs his medicines entirely against it, as if it were a cause. Thus, forgetting what he had just before advanced, that the spasm is occasioned by debility, he recommended the most debilitating medicines and regimen to cure people already too much debilitated; and to such practice his enemies alledged that many fell victims. The theory and practice, however, still kept its ground; and as great numbers of students were every year bred up in the belief of it at Edinburgh College, who carried the principles of their teacher to all parts of the world, it bade fair for becoming universal. But, in the midst of this eclat, the whole system received such a rude shock from the doctrines of John Brown, though at that time not even M. D. as it hath not yet recovered.

Though the author of the new system contended, as much as Dr. Cullen, for the supremacy of the nerves, he did not upon that foundation attempt to establish his practice. He considered the living body as one machine, the whole of which might be acted upon, and always was acted upon by certain powers. It possesses a certain inexplicable property called excitability, capable of being augmented or diminished. Every power which augments the excitability he called a stimulus; the opposite would have been a sedative; but according to this system there is not any sedative, nor can there be one in nature. The reason is, that excitability itself has no existence but in consequence of the action of certain powers called stimulants. The total subduction of these reduces the excitability to nothing; of consequence no power can act against it in a state of non-existence. What other physicians call sedatives, therefore, according to the new system, are only weak stimulants. The fallacy of such reasoning is obvious; but as it does not affect the practice, we shall not spend any time in considering it further.

On the principles just now laid down, the Brunonian system divides all diseases to which the human body is liable into two great classes; the one produced by too much excitement, the other by too little. The former contains those diseases by other physicians called inflammatory; the latter such as are called nervous, putrid, or all in which the powers of life are too weak, and require to be supported. This last is supposed to be much more numerous than the former; and in the cure of these it was that the founder of the system appeared to greatest advantage. A most violent altercation took place between Dr. Brown and the Edinburgh College; yet, notwithstanding all the influence of the professors, and their unanimous opposition to the new doctrines, they found themselves ultimately unable to resist a single man unsupported either by wealth or reputation. The plausibility of his system, and its being obvious to every capacity, overcame every obstacle; so that even the practice of the Cullenians themselves underwent considerable alterations. It is not, however, to be denied that the system hath been considerably improved, or at least altered, by some of Dr. Brown’s pupils, who have had the advantage of extensive practice, and of visiting many different countries; which the Doctor himself never had. His materia medica was besides exceedingly confined; the only medicines he had any great opinion of, being laudanum and ardent spirits. The Peruvian bark he held in very little estimation, as being a weak stimulus. He seems to have been unacquainted with the virtues of mercury, except in the venereal disease, and most probably would have given laudanum in those cases of fever where mercury is found by others to be so efficacious. But this deficiency hath been abundantly supplied by some of his followers. In a work entitled “The Science of Life,” published by Dr. Yates and Mr. McLean, practitioners in the East Indies, we find mercury exhibited in prodigious doses. As a specimen we shall select their third case, which was a dysentery. On the first of September the patient took two grains of calomel and as much opium every two hours. This was continued for two days. On the third, the dose was given every hour; besides which, he had half an ounce of mercurial ointment with a drachm of calomel rubbed into his body. Next day the pills were continued, and the quantity of ointment tripled by thrice rubbing in. This was continued for three days, at which time, an eruption on the skin appearing, it was feared he could not be salivated; this eruption being a sign that no salivation could be produced. The same mode of treatment, however, was persisted in. September 7th the calomel in the pills was augmented to four grains; the warm bath was used, and the ointment continued; but at night twenty grains of calomel and six of opium were given every two hours. At the same time two ounces of ointment, with four of calomel, were ordered to be rubbed in. Next day, though his pulse was almost imperceptible, and his extremities cold, “the medicines were continued as far as circumstances would admit;” with what view it is not said, nor indeed is it easy to be discovered. At one in the morning, however, the patient died; an event not at all surprising. Our authors excuse themselves for this failure by saying that the viscera of the patient were diseased, as was evinced by the impossibility of exciting a salivation; and “that when a patient is evidently incurable by the common practice, it becomes the duty of the practitioner to depart from it.”

No doubt we may readily assent to both these assertions; but though a patient be evidently incurable by the common practice, or by any other, there is no necessity for killing him, or for persevering in a course of violent medicines that evidently make him worse. The whole of this case indeed strongly militates against the doctrine of excitement; for if mercury be such a powerful stimulus to the powers of life in general, how comes it to pass that in the present case the unhappy patient, instead of being in the smallest degree excited, was prodigiously debilitated, and that from the very first time of taking the medicines. This will appear from the following table, exhibiting the symptoms of the disease as they kept pace with the medicines taken.

Days of the Month. Medicines taken. Symptoms.

August 29 & preceding. Ordinary doses of mercury and opium. Pain of bowels, and frequent stools, growing worse.

Sept. 1 & 2. Opium and mercury, two grains each, every two hours; besides opiate draughts. Still increasing.

3d The opium and mercury as before, but now given every hour; half an ounce of mercurial ointment, with 60 grains calomel. Stools very frequent, with violent pain in the bowels; extreme thirst, tongue furred, and no sleep.

4th Pills as usual. Ointmt. thrice rubbed in, once with 120 grains of mercury. Vomiting during the night. Tongue brown and furred.

5th Medicines as before. Violent pain in bowels.

6th Medicines as before. Extreme pain on pressing the arch of the colon; frequent stools, profuse sweats, great dejection of spirits.

7th Pills as before, with four grains of calomel. Mercury in the ointment increased to half an ounce. Warm bath. At night an ounce of mercurial ointment, with two ounces calomel. As yesterday. An eruption on the skin. At night incessant stools, with violent pain in the belly; profuse sweat.

8th Pills, ointment & calomel as before. Warm bath thrice. At night two ounces ointment, with four of calomel. Incessant stools with violent pain; at night with blood. Extreme debility.

9th Medicines of the same kind, as many as could be taken. Stools innumerable; extremities cold, pulse scarce to be felt.

10th Death at one in the morning.

From a consideration of this patient’s symptoms, in comparison with the quantity of mercury taken, it most evidently appears, that it acted in no other way than as an irritating poison; affecting, with extreme violence, the already diseased intestines, and, instead of exciting the vital powers of the whole system, manifestly destroying them. Let it not be imagined, however, that this case is selected from the rest merely because it was fatal, or because it affords an opportunity of finding fault with the practice recommended in the book. It is the only one in which the mercury had a fair trial; and even here it was not very fair, as being conjoined with a great quantity of opium. In the other cases, which terminated favourably, the mercury was overpowered by such horrible doses of opium, that we cannot tell which medicine had the greatest share in the cure; besides, that in other cases the patients were allowed the free use of wine, which we all know to be a powerful stimulant and cordial; but it is not said that the poor man, whose case is above related, had a single drop of wine, or any thing else, except opium, to support him against the action of such a violent medicine.

On this case it is of importance still to remark, that it affords, in the strongest manner, an argument against what our authors say, p. 86, that “mercury acts by supporting the excitement of the whole body, it invigorates each particular part; and thus occasions, to a certain extent, the regeneration of those organs which may have been injured by disease.” In the instance adduced, there is no evidence of a stimulus upon any other part of the system than the bowels, which were already debilitated or diseased in such a manner that they could not bear it. The system in general, instead of being excited, was sunk and debilitated from the very first moment, until at last the excitement terminated entirely by the patient’s death. But further: There is very little probability that mercury or any other medicine whatever can prove a general stimulus, and that for the following reasons.

1. No medicine can assimilate with the substance of the body. Medicines properly so called are here alluded to. Food or drink of any kind taken for the support of the body while in health, however they may act medicinally upon occasions, are excepted.

2. The body is composed of many various substances, each differing in its nature from the other. The nature of the medicine, whatever it may be, is uniform, and cannot act upon substances of different kinds in an uniform manner; and without this there can neither be an universal stimulant, nor an universal debilitant.

3. All medicines, being incapable of assimilation with the body, must be considered, when taken into it, as foreign matter; and the introduction of them at any rate is in fact the creating of a disease. This is evident from multitudes of instances where people by quacking with themselves, and taking medicines unnecessarily, have destroyed their health.

4. As every medicine has one peculiar nature, and one mode of action in consequence of that nature, it must, when introduced into the body, where there are fluids of various natures, act upon one of them more than the rest; and this may be called the chemical action of that medicine upon the body.

5. In consequence of the chemical action of the medicine, the mode by which it is expelled out of the body will be different; for, as all medicines are extraneous substances, they must be sent out of the body as fast as possible; and it is their action upon one particular part which promotes their expulsion. Thus, if from the nature of the medicine it acts in a certain way upon the stomach and bowels, it will vomit or purge, or perhaps both; and by this action it is expelled from the body, along with whatever other matters happen to be in the stomach or intestines; and thus medicines do good only accidentally; for mere vomiting or purging are most certainly diseases; but where noxious matters exist in the bowels, and do not naturally excite these operations, an emetic or purgative is unquestionably useful. Here the authors of the Science of Life reason differently; and it is worth while to refute their argument, as being the foundation of such tremendous practice as nobody of common sense would choose to be the subject of. Of tartar emetic they speak in the following terms. “That tartar emetic is a stimulant of very high power, is evident from the small quantity of it which produces the state of indirect debility that occasions vomiting. It should be given in such a manner as to increase and to support the excitement. But this will be found difficult, as the duration of its action seems to be even shorter than that of opium. If its action does not continue more than a quarter of an hour, might it not be repeated at such short intervals, and the doses so reduced as to allow the establishment of the indirect debility?” This is arguing in a circle. They first suppose that vomiting is occasioned by indirect debility, that is, the weakness produced by an excessive stimulus to the whole system, as in cases of drunkenness; and then, from the existence of vomiting, they prove that a general stimulus had pre-existed. The cases, however, are widely different. In cases of drunkenness, the person feels himself at first exhilarated, alert and active, which shows the existence of a general stimulus. But who has ever found himself exhilarated by taking a dose of tartar emetic? Yet in a general excitement it is absolutely necessary that this exhilaration should take place, because it is an inseparable consequence of an addition of vital power, let it come in what way it will. Thus we know that if a person happens to be much exhausted by fatigue and abstinence, he will be exhilarated and his strength augmented by a single mouthful of meat, as well as by a glass of wine. This shows that both these are general stimulants to the system; but what medicine have we that will produce similar effects? Perhaps opium comes the nearest in the whole materia medica; but the uneasiness it occasions in the stomach manifests a greater action upon it than the other parts; for if the whole body were equally excited, the withdrawing of the stimulus, or its naturally losing its force, could only have the same effect with fasting or fatigue; but the debility of the stomach, the confusion of the head, and other effects which attend a dose of opium, demonstrate that it acts partially, and not equally over the whole body. The Science of Life indeed says that these effects are owing to the improper omission of the medicine, or not repeating the doses in due time. This may be; but no improper exhibition of food, or want of due repetition, will produce such symptoms; which undoubtedly is a proof that food stimulates the system in one way, and opium in another.

6. If any medicine could be found that acted as an universal stimulus or exciter of the whole system, it could not like others be expelled, by any particular evacuation; but, by destroying the balance between the force of the acting powers and the subject on which they act, would most certainly kill, unless very powerful means were used to counteract its effect. The only stimulant we are acquainted with which acts equally on the whole system, and which can be readily exhibited as a medicine, is that pure kind of air called by Dr. Priestley dephlogisticated, by Scheele empyrean, and by the French chemists and their followers oxygen. The exciting powers of this air, when breathed instead of the ordinary atmosphere, are astonishing. It not only augments the appetite, but the power of the muscles, and the inclination to use them; so that without any intoxication or delirium the person cannot refrain from action; and it not only exhilarates the spirits in an extraordinary manner, but beautifies the face. Did the cure of diseases therefore, or any set of them, depend on mere excitation, no other medicine but oxygen would be necessary. What effects it may have in diseases of debility is not yet ascertained; but to persons in health it certainly proves fatal: their bodies are unable to bear its powerful action, and of consequence they waste, and would die of consumptions, if its effects were not counteracted. Nor is this at all an easy matter; for Dr. Beddoes informs us that, by breathing this air for a short time each day, only for three weeks, he found himself in great danger of a consumption, and was obliged to use much butter and fat meat in his diet, besides giving up the use of the air altogether, in order to get clear of its mischievous effects.

Another mode of stimulating or exciting the whole system is, by putting into it a larger quantity of blood than it naturally contains. This is entirely similar to the breathing of oxygen; especially if arterial blood be used, which has already imbibed its spiritous part from the atmosphere. In the last century the transfusion of blood was proposed not only as a mode of curing diseases, but of restoring old people to youth; and Dr. McKenzie, in his Treatise on Health, quotes from the memoirs of the Academy of Sciences several instances of the blood of brute animals being infused into human veins, without any inconvenience. It seems, however, not only a bold but an unnatural attempt to use the blood of beasts for such a purpose; and, however lavish mankind may be of their blood upon certain occasions, it is to be feared that there are few who would be willing to spare any to relieve another from sickness; but indeed little can be said about the practice; as, on account of some bad consequences, or failures, it was forbidden by the king of France, and by the pope’s mandate in Italy, and has now fallen into disuse. In a paragraph at the end of Heister’s surgery (4to edition) it is asserted that the transfusion of blood was productive of madness. Dr. Darwin, however, in his Zoonomia, still proposes the transfusion of blood as a remedy, and even describes a convenient apparatus for performing the operation. In one part of his work he says, “Might not the transfusion of blood, suppose of four ounces daily, from a strong man, or other healthful animal, as a sheep or an ass, be used in the early state of nervous or putrid fevers?” In another place he mentions his having proposed it to a gentleman whose throat was entirely closed up by an incurable swelling, so that he could swallow nothing. This is a disease not very rare, and which always must be fatal; because the patients, though not affected by any sickness, die of hunger; and, to relieve them from this miserable situation, extraordinary attempts are not only allowable but laudable. The Doctor proposed to his patient, “to supply him daily with a few ounces of blood taken from an ass, or from the human animal, who is still more patient and tractable, in the following manner: To fix a silver pipe, about an inch long, to each extremity of a chicken’s gut, the part between the two silver ends to be measured by filling it with warm water; to put one end into the person hired for that purpose, so as to receive the blood returning from the extremity; and when the gut was quite full, and the blood running through the other silver end, to introduce that end into the vein of the patient, upwards towards the heart, so as to admit no air along with the blood. And, lastly, to support the gut and silver ends on a water plate filled with water of 98 degrees of heat; and, to measure how many ounces of blood were taken away, to compress the gut from the receiving pipe to the delivering pipe.” The gentleman desired a day to consider of this proposal, and then another; after which he totally refused it, saying that he was now too old to have much enjoyment of life, and that, being so far advanced in a journey which he must certainly accomplish sooner or later, he thought it better to proceed than return. The Doctor informs us that he died a few days afterwards, seemingly very easy, and careless about the matter. One experiment of this kind I have been witness to; not indeed on a human creature, but on a calf. This creature received into one of its jugular veins a considerable quantity of blood from the carotid artery of another, nearly of the same age (about a month, or little more.) It was impossible to say any thing about how much was transfused; only the bleeding was continued till the animal which lost the blood began to shew signs of faintness. The artery was then tied up, and the orifice in the jugular vein closed. The calf which had lost the blood appeared very languid and faint, but lived a few days in a drooping state; when it either died of itself, or was killed, as being supposed past recovery. The other, which had received the blood, appeared to be in every respect highly excited. It became playful, even in the room where the operation was performed, its eyes assumed a bright and shining appearance, and its appetite was greatly increased. Thus it continued for about a fortnight; appearing all the time to be in high health, and eating much more than usual; but at last died suddenly in the night. From these effects on healthy subjects, however, we cannot infer what would happen in such as are diseased; but it is plain that if the cure of diseases were to depend upon mere excitation, the means are in our power, without any local irritation, which always must take place in some degree by the use of ordinary medicines. This path is not absolutely untrodden: the pneumatic practitioners of the present day have tried oxygen in consumptions, and found it pernicious; and Dr. McKenzie informs us that the transfusion of blood was tried ineffectually in the same.

7. As all the medicines usually prescribed at present are only to be accounted partially stimulant, or as acting upon particular parts of the system, we see that some may promote one evacuation, and some another; while all produce some change in the organization, which may prove useful or detrimental, may increase the disease or cure it, or may produce another, according to the judicious or injudicious application. But for a knowledge of all this we must be indebted to experience: there is not a theory on earth that can lead us a single step.

Before we dismiss the consideration of medical theories, however, it will still be necessary to give some account of the new system as it hath branched out in various ways: for though the fundamental principle is now received by a great number of physicians, yet the superstructure is exceedingly different from what Dr. Brown himself erected and, indeed, from the very same principles we find conclusions made as directly opposite to one another as can be expressed in words. Drs. Yates and McLean, for instance, at Calcutta in the East Indies, have concluded that the plague “is a disease of a very high degree of exhaustion;” which Dr. Brown would have called debility. Dr. Rush at Philadelphia, proceeding also upon the Brunonian principles, determines it to be the most inflammatory of all diseases,62 and which Dr. Brown would have called a disease of excitement. These two doctrines are, in every sense of the word, as distant from one another as east from west. Let us then consider both, if any consideration can avail us on the subject.

By the ancients it was supposed that diseases were occasioned by something either bred in the body or received into it, and that the power of nature produced, during the course of the disease, a certain change in this matter, called coction, or concoction; which, if we please, we may express by the English word cooking. The matter of the disease, called also morbific matter, thus cooked, was in a state proper for expulsion, and was therefore thrown out by sweat, vomit, stool, &c. or it might be expelled artificially, which could not have been attempted with safety before. Modern systems deny the existence of morbific matter, and resolve all into an affection of the nerves, according to Dr. Cullen by certain sedative causes, but according to Dr. Brown by an accumulation in some cases, and an exhaustion in others, of the excitability or excitement of the body. The Science of Life commences with stating what they suppose to be an improvement of the Brunonian principles, and from which the following account of the origin of diseases is extracted. “Upon the different states of excitability depend all the phenomena of health and disease. There are three states of the excitability. 1. The state of accumulation; when a portion of the usual stimuli is withheld. . . . When a portion of the usual stimuli is withheld, the excitability accumulates, and the body becomes susceptible of impression in the direct ratio of the subduction. This state constitutes diseases of accumulation, or of direct debility. 2. The middle state; when the excitability is such that the application of the accustomed degree of exciting powers produces tone or health. 3. The state of exhaustion. When the application of stimuli has been greater than that which produces healthy action, the excitability is exhausted, and the body becomes less susceptible of impression in the direct ratio of the excess. This state constitutes diseases of exhaustion, or of indirect debility. The states of accumulation and exhaustion of the excitability, in their different degrees, constitute all the diseases to which living bodies are subject.”

Here the chime runs on the word excitability, which is not defined. If we call this property life, then we are only informed, that, as life is more or less vigorous, the body enjoys a greater or smaller degree of health; which we know without any medical instructor. If, instead of the accumulation and exhaustion of excitability, we take the original doctrine of excitement and debility laid down by Dr. Brown himself, we are nothing better. The whole theory is lost for want of the definition of a single word. As long as excitability remains an unknown property, we can explain nothing by it. We may indeed vary our terms. We may call it nervous influence with Dr. Cullen, or sensorial power with Dr. Darwin; but we shall still be as much in the dark as ever; and all that can be made out of our theories, when our language is decyphered, must be, that sometimes people are well, and sometimes they are sick!

Dr. Rush, in his Treatise on the Proximate Cause of Fever, adopts in part Dr. Brown’s system pretty nearly as the author himself laid it down. “Fevers of all kinds (says he) are preceded by general debility. This debility is of two kinds, viz. direct and indirect. The former depends upon an abstraction of usual and natural stimuli; the latter upon an increase of natural, or upon the action of preternatural, stimuli upon the body. . . . Debility is always succeeded by increased excitability, or a greater aptitude to be acted upon by stimuli. . . . The diminution or abstraction of one stimulus is always followed by the increased action of others.” Here it is evident we are as much in want of definitions as ever. We know neither what excitability is, nor what debility is, and yet they are both held out as the causes, and proximate or immediate causes, too, of symptoms produced by things quite obvious to our senses. Thus cold and heat, with which we are daily conversant, are only called the predisposing causes of fever; while debility and excitement, words to which we have no meaning, are said to be the proximate cause. It would certainly be better to throw away such words altogether, and say that cold, heat, &c. cause fevers, without troubling ourselves farther about the matter.

It remains now to take into consideration the pneumatic theories, founded upon the discoveries made by Dr. Black, Dr. Priestley, Lavoisier, and others, concerning various kinds of aerial fluids, or gases,63 as they are also called. Some of these, particularly that afterwards called fixed air, were discovered by Van Helmont. Considerable advances were made by a German chemist, named Mayow, in the last century; but his book had fallen into such oblivion that his name was scarce ever mentioned, until his discoveries were repeated, and still greater advances made by others. Dr. Hales obtained air from a great many different substances, but was unable to ascertain any thing concerning its nature. Dr. Black of Edinburgh laid the foundation of pneumatic chemistry, by discovering that a certain species of air is capable of being absorbed by earths of different kinds, and that many very heavy substances owe at least one half of their weight to this condensed air. The discovery was accidental. Wishing to obtain a very pure and white lime, he had recourse to the fine white earth called magnesia alba. Some of this he distilled with a heat sufficient to make the vessel red hot. Only a very small quantity of water came over, but the magnesia had lost almost two thirds of its weight. This immense loss was found to arise from an emission of air during the operation; and by other experiments it was likewise found that the air might be transferred from one portion of magnesia to another from which it had been previously expelled; that the existence of this species of air in certain bodies was the cause of that fermentation which takes place when any acid is poured upon them, as vinegar upon chalk or potash. Hence if any of these substances be deprived of its air, it will not any longer ferment in this manner. It must not be forgot, however, that when air thus unites itself with any terrestrial substance it no longer has its former properties. It is reduced exceedingly in bulk, and in proportion to this reduction only the body is increased in weight; and therefore though we say that the air is absorbed, we must still remember that only one part of it is so, and that by far the least considerable in bulk. A violent fire will always expel the air again, and restore it to its former bulk; and again the condensation or absorption of the air is always attended with the production of heat. This last property was not much attended to by Dr. Black, but others have observed it; and the late Dr. Charles Webster of Edinburgh published a theory in which he maintained that condensation was in all cases the cause of of heat. But, however true it may be that condensation of any kind is followed or accompanied by heat, it is evidently necessary to know the cause of the condensation also, otherwise we make no advance in solid theory.

The aerial fluid, discovered by Dr. Black, was one of those most commonly met with. He called it fixed air, from its property of adhering or fixing itself to different bodies. It was found to be the same with that which had been discovered by Van Helmont, and by him named gas sylvestre (spirit of wood)64 or the fume of charcoal; it was found to be the same with the steam of fermenting liquor, and with that very frequent and dangerous vapour, met with in coal mines, called in Scotland the choke-damp. Like other discoveries, this was quickly pushed beyond its proper bounds, and applied to the solution of phenomena which it could not solve. Dr. MBride, particularly, supposed it to be the bond of union between the particles of matter, or in other words the principle of cohesion itself. It was also supposed to be the substance of those scorching winds, called samiel, met with in Asia and Africa, and which sometimes prove fatal to travellers. The pernicious vapours called mofetes, which sometimes issue from the old lavas of Vesuvius in Italy, were likewise supposed to be the same;65 but of this, particularly with regard to the samiel, there seems to be no sufficient evidence.

The industry of other experimenters did not long leave theorists without abundance of materials upon which they might exercise their talents. It is impossible in this place to assign to each his proper rank in the way of discovery, or indeed to mention their names. Dr. Priestley has distinguished himself far above the rest. He not only repeated and improved Dr. Black’s experiments on fixed air, but likewise found out a number of other kinds; particularly that from animal substances in a state of putrefaction, which is so pernicious to living creatures, insects excepted; for these last will thrive amazingly in air that would prove certain death to a man. He also discovered that this kind of air, and some others, were absorbed by vegetables, and thence inferred the use of vegetables in purifying the atmosphere. He even analysed the atmosphere itself, and found that it consisted of two different kinds of fluids, one of which he called dephlogisticated, the other phlogisticated air. The former was found to support animal life for a time, the latter to destroy it instantly. Their effects upon fire were the same; the former exciting the most vehement heat and bright flame, the latter extinguishing a fire at once.

The fame of Dr. Priestley’s discoveries quickly reached the continent of Europe; the French chemists repeated his experiments with improvements, as they thought; and indeed certainly made many curious discoveries. Lavoisier was particularly remarkable for his numerous and accurate experiments; but, by his changing entirely the language of former chemists, and substituting a set of new terms of his own invention, he certainly entailed the greatest curse upon the science it ever met with. It belongs not to this treatise to give an account of his system farther than to say, that, from the immense proportion of condensed aerial matter found in most terrestrial substances, he and his followers were led to conclude, that different species of air constitute almost the whole of the terraqueous globe. Water particularly they have absolutely and most positively determined to be a composition of two airs condensed, viz. the dephlogisticated and inflammable, which they call oxygen and hydrogen. However, this doctrine is still opposed by Dr. Priestley and some others.

In the midst of so much theory, and so many new and surprising discoveries, it would have been wonderful indeed if the science of medicine had kept free from innovation. It did not: the new chemistry, with all its formidable apparatus of hard words, was introduced, and thus the study of the science, already very difficult, was rendered still more so. In passing this censure upon the modern nomenclature, as it is called, I am sensible that I must rank with the minority; nevertheless, I have the satisfaction of finding that I am not altogether singular. Dr. Ferriar, in the preface to his second volume, complains, “that, with every attempt towards the formation of a system, new applications of words are introduced, which, though desirable in the art of poetry, are very inconvenient in pathological books, especially when this is done to give an air of novelty to old theories and observations. For, between the ancient language, which practitioners cannot entirely reject, and the new dialect, which they cannot wholly adopt, the style of medical books is reduced to a kind of jargon, that the author himself may possibly understand, but which his readers find it very difficult to unriddle. Hence results a neglect of medical literature, and hence the pernicious habit of regarding as new whatever has not appeared in the publications of the last half century.” To the same or a similar purpose, in the preface to his first volume, he cites Quintilian.66 “Some have such a multitude of vain words, that, while they are afraid of speaking like other people, by a kind of affected elegance, they confound every thing they have to say with their immense loquacity.”

The pneumatic system naturally arose from a consideration of the composition of the atmosphere we breathe. Finding this fluid to be composed of two others, the one of which would preserve life for some time at least, and the other instantly destroy it, it became natural to think that diseases might be produced by any considerable variation in the proportion of these ingredients. An instrument was soon invented by which any considerable variation in this respect might be discovered; but upon trial this was found to be of very little use. Dr. Priestley himself tried, by means of this instrument, some very offensive air which had been brought from a manufactory, and could find no remarkable difference between it and that which was accounted pure. Still, however, it was evident that by increasing very much the proportion of one of the ingredients, some considerable alteration might be produced, which could not but be perceptible in the human body; and this led to the application of aerial chemistry to disorders of the lungs. The mixture chosen for this purpose was pure dephlogisticated (oxygen) with inflammable air (hydrogen;) and, though this has not been known to effect a radical cure, it certainly has given relief in many cases. In fevers also the application of fixed air (carbonic acid) hath been found advantageous; but with regard to oxygen and some others we have not yet a decided instance of their good effects in any case. Dr. Beddoes indeed is of opinion that it would be of service in the sea-scurvy; but in this (whether his conjecture be right or wrong) the theory is certainly erroneous, as shall presently be evinced.

In considering the pneumatic system it is evident that modern chemists have fallen into the same error with their predecessors, viz. of supposing that every thing which by the force of fire or otherwise they could produce, from any substance, previously existed in it. Hence, as from a piece of bone for instance, a chemist can produce water, salt, oil and earth, it was supposed that these four were the principles or elements of the bone. But this was false reasoning; for if these were really the chemical principles, they ought to have been able to produce some kind of bony substance by mixing them together after they had been distilled. But no such thing could be done; and though we should add to the mixture the whole quantity of air emitted during the distillation, and which escaped the notice of ancient chemists, our success would be no better. In like manner, because in certain circumstances oxygen is obtained from the flesh of animals, it has been concluded that it necessarily exists as an ingredient in their bodies while living; and that, if this kind of air happens to predominate, the animal will be affected in one way, or if hydrogen prevail, in another. But though we have already quoted Dr. Girtanner with approbation as having obtained oxygen gas from fresh meat, yet this does not by any means prove to us that it exists in flesh as one of its component parts. Even in the Doctor’s experiment it was necessary to expose the flesh to the atmosphere in order to procure the gas by distillation; which undoubtedly must excite a strong suspicion that the air in question comes from the atmosphere itself; and, if this is the case, it is not reasonable to suppose that a disease could be cured by any addition of oxygen to the solid parts; because, though sound flesh may have an inclination to absorb this kind of air, we do not know whether it would have such a property of absorption in a diseased state. Indeed in the scurvy, which Dr. Beddoes chooses as an example, experiment seems to determine in favour of fixed air rather than any other. But let us hear Dr. Girtanner himself, who has at large discussed this subject in two memoirs; one upon the laws of irritability, and another on the principle of irritatibility.

In these memoirs we find the Brunonian doctrine set forth with such silence in regard to Dr. Brown himself, that some have not scrupled to charge Dr. Girtanner with literary theft; but this is a matter which belongs not to us to consider: the theory may be very good, whether stolen or not. He changes the word excitability, used by Dr. Brown, for irritability; but hath the misfortune of not being able to tell us what he means by it. He goes on, however, to distinguish the three states of tone or health, accumulation, and exhaustion, as other Brunonians do. Health, he says, in a fibre “consists in a certain quantity of the irritable principle necessary for its preservation. To maintain this state, the action of the stimulus must be strong enough to carry off from the fibre the surplus of this irritable principle which the lungs and the circulation of the fluids are continually supplying. For this a certain equilibrium is necessary between the stimuli applied and the irritability of the fibre, in fine that the sum of all the stimuli acting upon it may be always nearly equal; powerful enough to carry off from the fibre the excess of its irritability, and not so strong as to carry off more than this excess. . . . When the sum of the stimuli acting upon the fibre is not great enough to carry off all its excess of irritability, the irritable principle accumulates in the fibre, and then it is found in that state which I call the state of accumulation; the irritable principle accumulates in the fibre, its irritability is augmented, and the stimuli produce much stronger contractions than when the fibre only retains its tone. . . . When the sum of the stimuli acting upon the fibre is too great, the fibre is deprived not only of the excess of its irritability, but also of some portion of the irritable principle necessary for the tone of the fibre; or, more properly speaking, the fibre loses more irritability than it receives, and, of course, in a short time finds itself in a state of exhaustion; and this exhaustion will be either temporary, or irreparable.”

Here it is evident that we have nothing but Dr. Brown’s system, without the least explanation to render it more intelligible. A definition is still wanting. This invisible and incomprehensible property of irritability ruins our whole fabric; nor can the deficiency be supplied by human art or skill: of consequence we must abandon this part of the system entirely, and come to something more cognizable by our senses. It is impossible, however, to pass over in silence the amazing inattention of the author, in imagining that on such unintelligible principles he could explain other phenomena. “In the state of temporary exhaustion (says he) the fibre loses its tone, and fails for want of irritability. The application of a stimulus while it is in this state will not make it contract. Provided the stimulus be not very strong, it will produce no effect at all, but in a short time the irritable principle will accumulate afresh in the fibre, and then it will again contract. It is only by little and little that the fibre recovers its irritability. This truth, I dare venture to say, is as new as it is striking. It unfolds a vast number of phenomena hitherto inexplicable.” Here we have nothing but the pompous declaration of a fact already well known; viz. that not only a fibre, but the whole body, may be in a state of temporary insensibility, and yet recover either of itself or by the use of external means. How many people have fallen into a syncope, and yet recovered! How many limbs have become paralytic, and in time recovered their sense and motion! Yet this is all that we are informed of with so much parade and assumption of novelty. We know that when a person is in a faint he is insensible to ordinary stimuli, though very strong ones will rouse him; but what can we infer from this? Nothing; only we see it is so. Does it avail us any thing to be told that during the time of fainting the irritability is exhausted, and “in a short time the irritable principle will accumulate afresh;” in which case the patient will no doubt recover, unless he happens to be dead, which is the true meaning of an irreparable exhaustion of the irritability.

In speaking of the principle of irritability he expresses himself in the following manner. “I think that the oxygen is absorbed by the blood, and that the venous blood is oxygenated in the lungs during respiration. The most celebrated naturalists and chemists are of a different opinion: they think that the oxygen does not combine with the venous blood. According to them, this last loses carbon and hydrogen, and recovers the bright colour natural to it, without absorbing any thing from the atmosphere. . . . After having a long time attended the phenomena of respiration, and made many experiments upon this subject, I think it may be concluded that one part of the oxygen of the vital air combines with the venous blood, of which it changes the black colour, and makes it vermilion;67 the second part of the oxygen unites with the carbon contained in the carbonic-hydrogen gas, which exhales from the venous blood, and forms carbonic acid air; a third part unites with the carbon of the mucus, contained in great quantities in the lungs, and which is continually decomposing; this part also forms carbonic acid air; a fourth part of the oxygen combines with the hydrogen of the blood to form water.”

On this theory I shall only observe, that though I lay claim to the former part, I allow the Doctor all the latter part to himself; particularly where he speaks of the formation of water to be exhaled during respiration. The air in question consists of two parts, like fixed air already mentioned. One of these is capable of being attracted, condensed, or united with certain substances; the other vanishes, leaving no other traces of its having ever existed, but heat, greater or less according to circumstances. When the air is taken into the blood, one part of it undoubtedly combines with something thrown out by the lungs, and forms fixed air, of which our breath contains a considerable quantity. We know certainly that the condensable part of fixed air is formed out of the condensable part of the oxygen, with certain additions. As therefore great part of this condensable oxygen is thrown out in fixed air at every expiration, it is natural to suppose that all of it is so: at least we cannot know the contrary without a series of very difficult and tedious experiments, which have never been made by Dr. Girtanner or any body else. But if the whole of this condensable part be thrown out, none can enter the blood by the breath; and consequently whatever true oxygen may afterwards be expelled from that fluid, must be a factitious substance, formed either during the artificial process, used for distilling it, or by a natural process In the body itself. It is not therefore at all probable that the oxygen which flesh emits in distillation can be derived from the air by respiration.

Another and more probable source is the food and drink we take; all of which are more or less impregnated with air of different kinds, particularly fixed air. This, we know, very readily condenses, and certainly will do so when taken into the body. In this state it not only may, but certainly will, pass into the blood, and through all the different parts of the body, until, having accomplished its purpose, whatever that may be, it is thrown out by insensible perspiration, as has been already explained.

The conclusions drawn by Dr. Girtanner from his experiments are, 1. That the change of colour which the blood undergoes during the circulation is not owing to its combination with hydrogen air68. 2. The deep colour of the blood in the veins is owing to the carbon it contains. 3. That the vermilion colour of the arterial blood proceeds from the oxygen with which the blood is conjoined during its passage through the lungs. 4. That respiration is a process exactly analogous to the combustion and oxydation of metals; that these phenomena are the same, and to be explained in the same manner. 5. That, during circulation, the blood loses its oxygen, and charges itself with carbonic hydrogen air, by means of a double affinity. 6. That, during the distribution of the oxygen through the system, the heat which was united with this oxygen escapes; hence the animal heat. 7. That the great capacity of arterial blood for heat is owing to the oxygen with which it is united in the lungs.

On these propositions, which constitute in a great measure the fundamental principles of the doctrine of oxygenation of the human body, we may remark,

1. Nobody can reasonably suppose that hydrogen air is the cause of the dark colour of the blood in the veins, because there is no source from which it can be derived; and, besides, it is certain that no kind of air can exist in its elastic state in the blood, without destroying the life of the animal. Some experiments proving this are given by Dr. Girtanner himself. It is true that an aerial vapour, of the nature of fixed air, exhales from the body by insensible perspiration; but there can be no doubt that this receives its elasticity only at the surface of the body, and is expelled the moment it is formed. It has indeed been proved, by undeniable experiment, that no air of any kind exists in the larger veins; because a portion of a vein, included between two ligatures, being cut out, and put under the receiver of an air-pump, does not swell in the least when the air is exhausted, which yet must be the case, did the smallest quantity of elastic air exist in it.69

2. When the Doctor asserts that the dark colour of the venous blood is owing to the carbon it contains, he is in the first place chargeable with the error of former chemists, who supposed that every thing which could be extracted from any substance by fire, existed previously in it, in that very form in which it is extracted by the fire; and in the second place he speaks entirely at random, without even a shadow of proof. Nay, he himself tells us, that he has repeated two of Dr. Priestley’s experiments, which in the clearest manner demonstrate, that neither the addition nor the abstraction of carbon, or any thing else, give this dark colour to the venous blood. “A small glass tube (says he) filled with arterial blood, of a bright vermilion, was sealed hermetically,70 and exposed to the light. The blood changed its colour by degrees, and in six days became black as venous blood. The same experiment was repeated, with this difference only, that the tube was exposed to heat, and not to the light. The blood became black in a shorter time.” In these experiments it is plain, that if the blood contained oxygen at first, it did so at the last; the same with regard to carbon. How came it then to pass, that without either evaporation of the former, or addition of the latter, the change should be produced? If the oxygen imbibed by the blood in the lungs was sufficient to produce the red colour, why did it not preserve it? The case here is precisely similar to what happens with the calx of silver. When that metal is dissolved in aqua fortis, and again reduced to a solid form, it appears as a white powder, and will preserve its colour if carefully kept from the light; but if a vial be filled with it, and exposed to the sun, that side on which the light falls will in a short time become black, and this though the vial has been ever so carefully sealed.71 Formerly, chemists had a method of accounting for this appearance, as well as that of the venous blood, by what they called the evolution of phlogiston: but now that the very existence of phlogiston is denied, we are deprived of this resource. But, whatever words we may use, it is plain that in neither case have we any ideas affixed to them which can make the matter at all more intelligible than it was before. But with regard to the blood, we are at a considerable loss to understand what the natural colour of it is; and indeed the question can only be determined by examining the blood of a fœtus which has never breathed. If the arterial blood of such a fœtus be of a dark colour, resembling that in the veins of a grown person, we must look upon this to be natural to it, and we may as well inquire why a rose is red, or an iris blue, as why the blood is of a dark, and not of a bright red. But, if we find this dark red change to a bright scarlet in the arteries, as soon as the child has breathed, we have as much reason to conclude that the air occasions this superior redness, as that an acid is the cause of a red colour in the syrup of violets, or an alkali of a green colour in the same. Experiments are yet wanting to determine this matter. Mr. Hunter has observed that “in such fœtuses as convert animal matter into nourishment, they most probably have it (the colour of the blood) influenced by the air, such as the chick in the egg, although not by means of the lungs of the chick, we find the blood, in the veins of their temporary lungs, of a florid colour, while it is dark in the arteries.”—The probability therefore is, that the blood is naturally dark; by the elastic principle of the oxygen that it is rendered brighter; and that, this elastic principle being expended in the course of circulation, the fluid reassumes its original colour.

3. Though enough has already been said to evince that the superior redness of the arterial blood is derived from oxygen gas, we shall still quote two instances from Mr. Hunter’s Treatise on the Blood, which set this forth in the clearest manner; and these instances are the more remarkable, because they demonstrate the phenomena not of the dead, but of the living body. 1. A gentleman in an apoplexy, who seemed to breathe with great difficulty, was bled in the temporal artery. The blood flowed very slowly, and for a long time. It was as dark as venous blood. He was relieved by the operation; but, on opening the same orifice in two hours, the blood flowed of the usual florid colour. 2. A lady in an apoplexy was treated in the same manner, and Mr. Hunter observed, that when she breathed freely, the blood from the temporal artery assumed a bright red colour; but when her breathing was become difficult, or when she seemed scarce to breathe at all, it resumed its dark colour, and this several times during the operation.

4. Respiration is not, as Dr. Girtanner says, a process similar to the combustion and oxydation (the calcination) of metals. Some of these by calcination, and all of them in the opinion of Dr. Girtanner, unite with the condensable part of the oxygen contained in the air, while the elastic part is dissipated in flame or heat. The reverse of this takes place in breathing; for here the elastic part of the oxygen unites with the blood, and makes it warm, while the condensable part, uniting with certain particles to be thrown off from the body, passes away in fixed air. Thus the process of respiraton does not resemble the calcination of a metal (at least according to our author’s opinion of that operation) but rather the inflammation of some combustible substance; for in both cases a certain quantity of carbon is found to be united with the basis of oxygen in the atmosphere, and thrown off from the place of combustion; and thus a quantity of fixed air is produced from every burning substance. Just so is it with respiration. If the condensable part of the oxygen combined with the blood, then no fixed air could be produced; or if any part of the oxygenous base was absorbed, it must certainly be known by a proportional deficiency in the quantity of fixed air produced. But there are no experiments made with accuracy sufficient to determine this point. It is true that many very able physiologists, as Borelli, Jurin, &c. have been of opinion, that part of the air is absorbed in respiration; but when we come to particulars nothing can be determined. Dr. Hales by experiment found the quantity absorbed to be a sixty-eighth part of the whole quantity inspired; but, on account of supposed errors, he states it only at an hundred and thirty-sixth part. Between these two the difference is so enormous, that we know not how to draw any conclusion from them. The French chemists are more decisive, and agree pretty well with one another. Chaptal calculates it at three hundred and fifty-three, and La Metherie at three hundred and sixty, cubic inches in an hour. Allowing these experiments to be just, the next question is, what part of the air is absorbed. Lavoisier says, that it is the oxygenous base, or the same with that which is absorbed in the calcination of mercury. But how comes he to know this? Surely not in the same way that he determines the absorption of it by mercury. In the latter case he takes a certain quantity of mercury, includes it in another known quantity of oxygen air, and heats the metal by means of a burning-glass or otherwise: the consequence is, that the air is absorbed, the mercury loses its fluidity, and is increased in weight. The metal gains the whole weight of the air absorbed; and, by another process, all the air and all the metal, or very nearly so, may be obtained in their original form. This experiment is so decisive, that nothing can be said against it with any shadow of reason; but who hath made, or who can make, similar experiments with the blood of a living man? Such experiments indeed might be made, if insensible perspiration did not stand in our way. Common atmospherical air is about eight hundred times lighter than water. A cubic inch of distilled water, according to Dr. Kirwan, weighs two hundred and fifty-three grains and a quarter. Oxygen air is somewhat lighter than common air: we shall therefore suppose that six hundred inches of it are equal to an inch of water. If then the blood absorb three hundred and sixty inches of air in one hour, it will in twenty-four hours have absorbed eight thousand six hundred and forty inches, equal in weight to fourteen inches of water and two fifths, which according to Dr. Kirwan’s estimate is between seven and eight ounces. But the quantity of matter insensibly perspired in that time is so much greater, that no calculation can be made. Here is one mode of determining the quantity of oxygen inspired totally impracticable in the human body, though quite easy and practicable in the case of mercury. The other mode of determining it by the expulsion of oxygen from the blood is equally impracticable. Dr. Girtanner indeed has expelled oxygen from flesh; but we know not in what proportion, nor can we determine whence it came. With regard to this last, indeed, there are two sources allowed by Drs. Beddoes and Girtanner themselves; viz. the absorption of oxygen by the lungs, and the quantity taken in with the aliment. A third source was also manifest from Dr. Girtanner’s experiments; viz. absorption from the atmosphere; for, by exposure to the atmosphere, flesh, which had once parted with its oxygen, became again impregnated with it. In this case therefore we must acknowledge that the uncertainty of the absorption by the lungs must be extremely great. A certain quantity of oxygen is undoubtedly thrown out in fixed air. How are we to determine this quantity? Certainly not by the first reverie that happens to occupy our imagination. It is a problem, the solution of which must be attended with the utmost difficulty. We must know, in the first place, how much oxygen was contained in the air inspired. In the second place we must know the quantity of fixed air expired. In the third place we must exactly know the proportion of oxygen contained in the fixed air thrown out by the breath. In the fourth place we must determine whether, by the conversion of oxygen into fixed air, any change is made in its bulk. For, if this shall be found to be the case, we should be led to suppose an absorption or augmentation of air when no such thing took place. This point therefore ought to be determined with the utmost accuracy. In the fifth place we must exactly know how much azote, septon, phlogisticated air is contained in the atmosphere inspired, and likewise in that expired. In the sixth place, we must be assured that there are no other fluids in the atmosphere capable of being absorbed by the lungs, excepting oxygen and azote. Whether there are any others or not, hath not been determined. From an expression of Dr. Fordyce, he would seem to be skeptical on the subject. “The atmosphere (says he) is found to consist of various vapours, of which air, or, as it has been called, pure air, or respirable air, (oxygen air) forms at present about a fourth. Gas (probably fixed air) forms some part;72 but the greatest part consists of one or more vapours, which, without any positive quality, but from that indolence which makes mankind in their researches attempt to find a resting place, have been considered by many chemists as one individual species, under the names of phlogisticated air,” &c. In the seventh place we ought to know what quantity of pure oxygen, unconverted into fixed air, or whether any such, is thrown out by the breath. That a quantity of this kind of air is really thrown out, is probable, because we can blow up a fire with our breath, and by a blow-pipe excite a most intense heat, capable of melting the most refractory metals, platina excepted. It is true that the eolipile, by the mere conversion of water into steam, will blow up a fire also; though, if the access of external air be denied, the blast of the eolipile will put the fire out. Probably the breath would do the same; but even this cannot be accounted a decisive proof of the oxygen being totally exhausted; for the moist vapour with which the breath abounds may extinguish the fire, even though some small quantity of oxygen should remain in it. It is not, however, our business at present to enter minutely into such discussions. From what has been already said, it is evident, that the absorption of oxygen by the blood, instead of being indubitably established, is of all things the most uncertain; the requisites for determining it being absolutely beyond the investigation of any person, however accurate. We may indeed, with great labour and trouble, determine that some part of the air is absorbed in breathing; but what that part is, we are unable to discover from any chemical investigation. The opinion of the simplicity of metals, and their being reduced to a calx by the adhesion of oxygen, has been so implicitly, and in a manner universally, received, that it has given a new turn to physiology, so that, by a kind of analogical reasoning, the human body has been reduced to a mere chemical apparatus, the operations of which may be calculated as we can do the event of experiments in a laboratory. But, after a very long and tedious contest, Dr. Priestley seems at last to have overthrown this doctrine of oxygenation, even in the inanimate parts of the creation; so that we can much less apply it to the doctrines of life and animation. His experiments are published in the third number of the Medical Repository, volume II, and fully demonstrate, that, though mercury absorbs oxygen during calcination, this is not the case with all metals; that in many cases the oxygen will unite with other substances in preference to the metal, which last is nevertheless reduced to a calx as though it had united with the oxygen; that in many cases the addition of weight gained by the calx is owing to mere water, &c. He has likewise shown that phlogisticated air (azote) is not a simple substance, as has been taught by the new chemists, but consists, as well as fixed air, of an union of oxygen with carbon, or at least with the black matter of burnt bones, with which he made the experiment. These aerial fluids therefore being so easily convertible into one another, and the uncertainty of the changes in bulk which may occur in consequence of these conversions so great, it is impossible to say whether a portion of the atmosphere in substance, i. e. both oxygen and azote, is absorbed, as physicians formerly supposed; or whether a portion of oxygen air alone be absorbed, as Dr. Beddoes supposes; or whether only the elastic principle itself is absorbed, and the diminution in bulk made in consequence of the conversion of oxygen into fixed air; I say, these matters depend on circumstances so much beyond the reach of our senses, that if we come to any probable conclusion upon the subject, it must be by analogical reasoning from other known facts, not from experiments made directly upon the living body; which, in their own nature, must, always be extremely vague and uncertain.