History of Civilization in England, Vol. 3 of 3

Thomson's Life of Cullen, vol. i. p. 70, Edinburgh, 1832.

821

Thomson's Life of Cullen, vol. i. p. 96. Bower states that Cullen ‘was appointed to the chair in 1755.’ Bower's History of the University of Edinburgh, vol. ii. p. 216, Edinburgh, 1817.

822

‘It seems impossible to peruse the passages I have quoted from Dr. Cullen's manuscript lectures and papers, and from his Essay on Evaporation, without perceiving that his investigations with regard to the heat and cold occasioned by the combination, liquefaction, and evaporation of bodies, must not only have assisted to direct the attention of his pupil Dr. Black to similar inquiries, but must also have furnished him with several of the data from which his simple and comprehensive theory of Latent Heat was afterwards so philosophically deduced.’ Thomson's Life of Cullen, vol. i. p. 56.

823

‘It is allowed by the admirers of this great man, that he was perhaps too fond of theory.’ Bower's History of the University of Edinburgh, vol. iii. p. 273

824

In 1759, he wrote to Dr. Balfour Russell, one of his favourite pupils: ‘You will not find it possible to separate practice from theory altogether; and therefore, if you have a mind to begin with the theory, I have no objection.’ Thomson's Life of Cullen, vol. i. p. 130. Compare his Introductory Lectures to the Practice of Physic, where, asserting truly, ‘that reasoning in physic is unavoidable’ (Cullen's Works, vol. i. p. 417), he boldly infers, ‘that to render it safe, it is necessary to cultivate theory in its full extent.’

825

Even Cullen himself says, rather roughly, ‘The great horde of physicians are always servile imitators, who can neither perceive nor correct the faults of their system, and are always ready to growl at, and even to worry, the ingenious person that could attempt it. Thus was the system of Galen secured in the possession of the schools of physic, till soon after the irruption of the Goths and Vandals destroyed every vestige of literature in the western parts of Europe, and drove all that remained of it to seek a feeble protection at Constantinople.’ Lectures Introductory to the Practice of Physic, in Cullen's Works, vol. i. p. 386, Edinburgh, 1827.

826

This idea runs through the whole of his writings. In the following passage, it is more succinctly stated than in any other: ‘In pathology, and in the prognosis of particular diseases, it is absolutely necessary to enter into the distinction of these causes. I call the one direct causes, those which act upon the nervous system directly; and the other indirect causes, those which produce the same effect, but by destroying those organs which are necessary to the support of the excitement, viz. the whole system of circulation.’ Cullen's Works, vol. i. p. 135. Even this passage, clear as it seems, can only be rightly interpreted by taking the context into consideration.

827

For, as is truly observed by probably the greatest pathologist of our time, ‘Humoral pathology is simply a requirement of common practical sense; and it has always held a place in medical science, although the limits of its domain have, no doubt, been variously circumscribed or interpreted at different times. Of late years, it has met with a new basis and support in morbid anatomy, which, in the inadequacy of its discoveries in the solids to account for disease and death, has been compelled to seek for an extension of its boundary through a direct examination of the blood itself.’ Rokitansky's Pathological Anatomy, vol. i. p. 362, London, 1854.

828

Unless, as is the case in geometry, the premisses, which are suppressed, are so slight as to be scarcely perceptible.

829

He was so indignant at the bare idea of a humoral pathology, that even Hoffmann, who before himself was the most eminent advocate of solidism, fell under his displeasure for allowing some little weight to the humoral doctrines. He says that Hoffmann ‘has not applied his fundamental doctrine so extensively as he might have done; and he has everywhere intermixed an humoral pathology, as incorrect and hypothetical as any other.’ Cullen's Works, vol. i. p. 410. At p. 470, ‘I have, therefore, assumed the general principles of Hoffmann. And, if I have rendered them more correct, and more extensive in their application, and, more particularly, if I have avoided introducing the many hypothetical doctrines of the Humoral Pathology which disfigured both his and all the other systems that have hitherto prevailed, I hope I shall be excused for attempting a system, which, upon the whole, may appear new.’

830

‘The solid parts of the body seem to be of two kinds: one whose properties are the same in the dead as in the living, and the same in the animate as in many inanimate bodies; the other, whose properties appear only in living bodies. In the last, a peculiar organization, or addition, is supposed to take place; in opposition to which the first are called the simple solids. Of these only, we shall treat here; and of the others, which may be called vital solids, being the fundamental part of the nervous system, we shall treat under that title in the following section.’ Cullen's Works, vol. i. p. 10.

831

These diseases are laxity, flaccidity, &c. See the enumeration of ‘the diseases of the simple solids,’ in Cullen's Works, vol. i. p. 14.

832

Cullen's Works, vol. i. pp. 65, 600, vol. ii. p. 364. Dr. Thomson, who had access to papers and lectures of Cullen's, which have never been published, says (Life of Cullen, vol. i. p. 265), ‘His speculations with regard to the different functions of the nervous system, but more particularly with regard to that of the Animal Power or Energy of the brain, were incorporated with every opinion which he taught concerning the phenomena of the animal economy, the causes of diseases, and the operation of medicines; and they may be said to constitute a most important part, if not the sole basis, of that system of the Practice of Physic, which he made the subject of prelection, as well as of study, for a period of nearly forty years, before he ventured to give it to the public.’ I should mention, that Cullen, under the term ‘brain,’ included the contents of the vertebral column as well as of the cranium.

833

Cullen's Works, vol. i. pp. 40, 546, 558, 648, vol. ii. p. 321.

834

Cullen's Works, vol. i. pp. 86, 91, 100, 101, 108, 115, 116, 553, 592, vol. ii. pp. 35, 366. Compare the summary of causes in Thomson's Life of Cullen, vol. i. p. 289.

835

He says (Works, vol. i. pp. 31, 32), ‘Whoever has the smallest tincture of metaphysics will know the distinction pointed at here between the qualities of bodies as primary and secondary.’ … ‘Whether these distinctions be well or ill founded, it is not my business to inquire.’ But though he did not deem it his business to inquire into the accuracy of these and similar distinctions, he thought himself justified in assuming them, and reasoning from them as if they could explain the working of those sensations, whose perversion formed the point of contact between metaphysics and pathology. See, for instance, in his Works, vol. i. p. 46, the long series of unproved and improvable assertions respecting the combination and comparison of sensations giving rise to memory, imagination, and the like.

836

Cullen, with that admirable candour which was one of the most attractive peculiarities of his fine intellect, confesses his want of acquaintance with the microscope: ‘It leaves me, who am not conversant in such observations, altogether uncertain with respect to the precise nature of this part of the blood.’ Cullen's Works, vol. i. p. 195. A pathologist without a microscope is an unarmed man, indeed. In regard to his animal chemistry, one passage may be quoted as a specimen of the manner in which he arrived at conclusions speculatively, instead of subjecting the phenomena to experimental investigation. ‘We may remark it to be highly probable, that all animal matter is originally formed of vegetable; because all animals either feed directly and entirely on vegetables, or upon other animals that do so. From hence it is probable, that all animal substances may be traced to a vegetable origin; and therefore, if we would inquire into the production of animal matter, we must first inquire in what manner vegetable matter may be converted into animal?’ Cullen's Works, vol. i. pp. 177, 178. The therefore and the must, resulting merely from an antecedent probability, are characteristic of that over-boldness, into which deduction is apt to degenerate, and which is strongly contrasted with the opposite vice of over-timidity, by which inductive reasoners are tainted.

837

Dr. Watson (Principles and Practice of Physic, 4th edit. London, 1857, vol. i. p. 41) says of the humoral pathology, that, ‘the absurdity of the hypothesis, and still more the dangerous practice which this doctrine generated, began to be manifest, and led to its total abandonment.’ But, with every respect for this eminent authority, I venture to observe, that this supposition of Dr. Watson's is contradicted by the whole history of the human mind. There is no well-attested case on record of any theory having been abandoned, because it produced dangerous results. As long as a theory is believed, men will ascribe its evil consequences to any cause except the right one. And a theory which is once established, will always be believed, until there is some change in knowledge which shakes its foundation. Every practical change may, by careful analysis, be shown to depend, in the first instance, on some change of speculative opinions. Even at the present day, many doctrines are generally held in the most civilized countries, which are producing dangerous practical consequences, and have produced those consequences for centuries. But the mischief which the doctrine engenders does not weaken the doctrine itself. Nothing can do that, but the general progress of knowledge, which, by altering former opinions, modifies future conduct.

838

Some writers, who have taken notice of Cullen, have been deceived in this respect by his occasional use of the expression ‘nervous fluid,’ as if he were willing to let in the idea of humorism. But, in one place, he distinctly guards himself against such misconstruction. ‘Now, to avoid determining any thing with regard to these opinions, I have used the term of nervous power; but as this is a little ambiguous, I choose to express it by nervous fluid; not that I suppose, with Dr. Boerhaave, that the brain is an excretory, and that a fluid is secreted from it: I mean nothing more than that there is a condition of the nerves which fits them for the communication of motion. But I defer the consideration of these opinions for the present, and perhaps ad Græcas calendas; but nothing shall be rested upon the nervous fluid, it shall be considered merely as a power fitted for communicating motions.’ Cullen's Works, vol. i. p. 17. Without this passage, his remarks on ‘the nervous fluid in the brain’ (Works, vol. i. p. 129), might easily be misunderstood.

839

‘Together with this, the languor, inactivity, and debility of the animal motions, the imperfect sensations, the feeling of cold, while the body is truly warm, and some other symptoms, all show that the energy of the brain is, on this occasion, greatly weakened; and I presume that, as the weakness of the action of the heart can hardly be imputed to any other cause, this weakness also is a proof of the diminished energy of the brain. So I conclude, that a debility of the nervous power forms the beginning of the cold fit, and lays the foundation of all the other phenomena.’ Practice of Physic, in Cullen's Works, vol. i. p. 492.

840

‘To render our doctrine of fever consistent and complete, it is necessary to add here, that these remote causes of fever, human and marsh effluvia, seem to be of a debilitating or sedative quality.’ … ‘Though we have endeavoured to show that fevers generally arise from marsh or human effluvia, we cannot, with any certainty, exclude some other remote causes, which are commonly supposed to have at least a share in producing those diseases. And I proceed, therefore, to inquire concerning these causes; the first of which that merits attention, is the power of cold applied to the human body.’ … ‘Besides cold, there are other powers that seem to be remote causes of fever; such as fear, intemperance in drinking, excess in venery, and other circumstances, which evidently weaken the system. But whether any of these sedative powers be alone the remote cause of fever, or if they only operate either as concurring with the operation of marsh or human effluvia, or as giving an opportunity to the operation of cold, are questions not to be positively answered.’ Practice of Physic, in Cullen's Works, vol. i. pp. 546, 552. One part of this view has been corroborated, since the time of Cullen. ‘The experiments of Chossat and others clearly prove cold to be a direct sedative.’ Williams' Principles of Medicine, 2nd edit. London, 1848, p. 11. Compare Watson's Principles and Practice of Physic, 4th edit. London, 1857, vol. i. pp. 87–92, 249. Hence, perhaps, the ‘irresistible tendency to sleep caused by exposure to severe or long-continued cold.’ Erichsen's Surgery, 2nd edit. London, 1857, p. 336; but as to this, Dr. Watson (Principles of Physic, vol. i. p. 89) is sceptical, and thinks that, in those cases which are recorded, the drowsiness ascribed to cold, is, in a great measure, the result of fatigue.

841

Cullen's Works, vol. i. p. 493. Compare, respecting his general theory of spasm, p. 84, and vol. ii. p. 400.

842

‘The idea of fever, then, may be, that a spasm of the extreme vessels, however induced, proves an irritation to the heart and arteries; and that this continues till the spasm is relaxed or overcome.’ Cullen's Works, vol. i. p. 494.

843

‘Such, however, is, at the same time, the nature of the animal economy, that this debility proves an indirect stimulus to the sanguiferous system; whence, by the intervention of the cold stage and spasm connected with it, the action of the heart and larger arteries is increased, and continues so till it has had the effect of restoring the energy of the brain, of extending this energy to the extreme vessels, of restoring, therefore, their action, and thereby especially overcoming the spasm affecting them; upon the removing of which, the excretion of sweat, and other marks of the relaxation of excretories, take place.’ Practice of Physic, in Cullen's Works, vol. i. pp. 501, 502. See also p. 636, § cciii. Or, as he elsewhere expresses himself (vol. i. p. 561): ‘With regard to the event of fevers, this is the fundamental principle: in fevers, nature cures the disease; that is, certain motions tending to death continue the disease, but, in consequence of the laws of the animal economy, other motions are excited by these which have a tendency to remove it.’

844

‘If we may trust to our conclusions with respect to the proximate cause, it follows, most naturally, from the view there given, that the continued fever is always owing to an excess of spasm, or to an excess of debility: as the one or other of these prevails, it will give one or other of the two forms, either the Synocha or inflammatory fever, or the Typhus or nervous fever.’ Cullen's Works, vol. i. p. 518.

845

‘Cullen's most esteemed work is his Nosology.’ Hamilton's History of Medicine, London, 1831, vol. ii. p. 279. ‘His Nosology will probably survive all his other works; it is indisputably the best system which has yet appeared.’ Lives of British Physicians, London, 1830, p. 213. ‘Celle de Cullen, qui parut en 1772, et qui constitue un véritable progrès.’ Renouard, Histoire de la Médecine, Paris, 1846, vol. ii. p. 231. See also Hooper's Medical Dictionary, edited by Dr. Grant, London, 1848, p. 937. But, in the most celebrated medical works which have appeared in England during the last twelve or fifteen years, I doubt if there is any instance of the adoption of Cullen's nosological arrangement. Abroad, and particularly in Italy, it is more valued.

846

‘I had rather not be cramped and hampered by attempting what abler heads than mine have failed to achieve, and what, in truth, I believe, in the present state of our science, to be impossible, a complete methodical system of nosology.’ Watson's Principles and Practice of Physic, London, 1857, vol. i. p. 9. This is the wisdom of a powerful understanding.

847

‘Now, when the diseases of Cullen's nosology have been almost doubled, and the facts relating to them have been more than doubled.’ Williams' Principles of Medicine, London, 1848, p. 522.

848

I had intended giving some account of the once celebrated Brunonian system, which was founded by Dr. John Brown, who was first the pupil of Cullen, and afterwards his rival. But a careful perusal of his works has convinced me that the real basis of his doctrine, or the point from which he started, was not pathology, but therapeutics. His hasty division of all diseases into sthenic and asthenic, has no claim to be deemed a scientific generalization, but was a mere artificial arrangement, resulting from a desire to substitute a stimulating treatment in the place of the old lowering one. He, no doubt, went to the opposite extreme; but that being a purely practical subject, this Introduction has no concern with it. For the same reason, I omit all mention of Currie, who, though an eminent therapeutician, was a commonplace pathologist. That so poor and thinly-peopled a country as Scotland, should, in so short a period, have produced so many remarkable men, is extremely curious.

849

Mr. Ottley (Life of Hunter, p. 186) says, ‘In his writings we occasionally find an obscurity in the expression of his thoughts, a want of logical accuracy in his reasonings, and an incorrectness in his language, resulting from a deficient education.’ But, a deficient education will never make a man obscure. Neither will a good education make him lucid. The only cause of clearness of expression is clearness of thought; and clearness of thought is a natural gift, which the most finished and systematic culture can but slightly improve. Uneducated men, without a thousandth part of John Hunter's intellect, are often clear enough. On the other hand, it as frequently happens that men, who have received an excellent education, cannot speak or write ten consecutive sentences which do not contain some troublesome ambiguity. In Hunter's works such ambiguities are abundant; and this is probably one of the reasons why no one has yet given a connected view of his philosophy. On his obscurity, compare Cooper's Life of Sir Astley Cooper, London, 1843, vol. i. pp. 151, 152; Paget's Lectures on Surgical Pathology, London, 1853, vol. i. p. 419; and the remarks of his enemy, Foot, in Foot's Life of Hunter, London, 1794, p. 59.

850

He was born in 1728, and came to London in 1748. Adams' Life of John Hunter, 2nd edit. London, 1818, pp. 20, 203. According to Adams (pp. 30–35), he was abroad as surgeon in the English army from 1761 to 1763; though, in Foot's Life of Hunter, London, 1794, p. 78, he is said to have returned to England in 1762. Mr. Ottley says that he returned in 1763. Ottley's Life of Hunter, p. 22, in vol. i. of Hunter's Works, edited by Palmer, London, 1835.

851

See Buckle's History of Civilization, vol. ii. pp. 374, 375.

852

‘He followed his natural inclination. He preferred the more delusive, apparently the more direct, road, which has seduced so many philosophers. He sought to arrive at the general laws of nature at once by conjecture: rather than, by a close and detailed study of her inferior operations, to ascend, step by step, through a slow and gradual induction to those laws which govern her general procedure.’ Babington's Preface to Hunter's Treatise on the Venereal Disease, in Hunter's Works, vol. ii. p. 129. Compare the narrow and carping criticism in Foot's Life of Hunter, p. 163.

853

That I may not be suspected of exaggeration, I will quote what by far the greatest of all the historians of medicine has said upon this subject. ‘La majorité des médecins qui prétendaient s'être formés d'après Bâcon, n'avaient hérité de lui qu'une répugnance invincible pour les hypothèses et les systèmes, une grande vénération pour l'expérience, et un désir extrême de multiplier le nombre des observations. Ce fut chez les Anglais que la méthode empirique en médecine trouva le plus de partisans, et c'est principalement aussi chez eux qu'elle s'est répandue jusqu'aux temps les plus rapprochés de nous. Sa propagation y fut favorisée, non-seulement par le profond respect que les Anglais continuent toujours de porter à l'immortel chancelier, mais encore par la haute importance que la nation entière attache au sens commun, common sense, et elle y demeura l'ennemie irréconciliable de tous les systèmes que ne reposent pas sur l'observation.’ Sprengel, Histoire de la Médecine, vol. v. p. 411, Paris, 1815.

854

Clive says, ‘Much as Mr. Hunter did, he thought still more. He has often told me, his delight was, to think.’ Abernethy's Hunterian Oration, London, 1819, p. 26.

855

Mr. Owen, in his interesting Preface to the fourth volume of Hunter's Works, says (p. vii.), ‘There is proof that Hunter anatomized at least five hundred different species of animals, exclusive of repeated dissections of different individuals of the same species, besides the dissections of plants to a considerable amount.’

856

‘Some idea may be formed of Hunter's extraordinary diligence, by the fact, that his museum contained, at the time of his death, upwards of 10,000 preparations, illustrative of human and comparative anatomy, physiology, and pathology, and natural history.’ Weld's History of the Royal Society, London, 1848, vol. ii. p. 92.

857

‘I have tested the conflicting evidence of these observers by dissection of the heart in the lobster; and you will perceive by this preparation that it is more complicated than even the Danish naturalist supposed, and fully bears out the opinion of Hunter in regard to the mixed nature of the circulation in the crustacea.’ Owen's Lectures on the Comparative Anatomy and Physiology of the Invertebrate Animals, 2nd edit. London, 1855, p. 318. ‘Cuvier, misled by the anomalous diffused condition of the venous system, supposed that there was no circulation of the blood in insects; yet the dorsal vessel was too conspicuous a structure to be overlooked. Such, however, was the authority of the great anatomist, that the nature of the heart began to be doubted, and the strangest functions to be attributed to it. Hunter, however, who was prepared to appreciate the true state of the circulating system in insects, by his discovery of the approximately diffused and irregular structure of the veins in the crustacea, has described, in his work on the blood, all the leading characters of the circulation in insects as it is recognized by comparative physiologists of the present day.’ Ibid. p. 383. Compare Hunter's Essays and Observations on Natural History, London, 1861, vol. i. p. 108.