Remarks on the unity of the body

Front matter

p)

I No. .H 1 5 g UNITED STATES OF AMERICA.

REMARKS

Preface

Although the science of Surgery may now be said to be founded on that " connexion of all parts with each other," which appears to have been a subject of such interesting contemplation to John Hunter, still it is to Mr. Abernethy that we are indebted for that practical application of it, which he so properly termed " The Constitutional Treatment of Local Diseases." Mr. Abernethy may truly be said to have revolutionized the science of Surgery ; since a practice which was formerly confined to, or at least was chiefly characterized by, ministering to a part, now commences (although it by no means excludes local remedies), and often successfully concludes, by measures directed to the correction of the disordered state of the constitution. So far Mr. Abernethy's principles are in useful iv

PREFACE.

operation ; but whether the state of the constitution be enquired into with the requisite industry, or ministered to with that scrutinizing attention to the various functions, on which the successful apphcation of these principles so much depends, may justly be questioned. Still more doubtful is it whether the exhibition of remedies be conducted with those logical cautions, on which we must rely for any approach to accuracy in our deductions, — important in all investigations, and in none more than those which relate to sciences so far from exact as Medicine or Surgery. It is not, perhaps, proper or expedient, in this place, to enquire into the causes whence the circumstances to which I have just alluded may have arisen. It is more to the purpose to assist in effecting their removal : and however humble any iota of contribution to this object may be, we should not reject it, if it appear well intentioned.

The constitutional treatment of local diseases is so beautifully illustrated, and so convincingly enforced, by considerations which refer to the chylopoietic viscera, that

PREFACE.

V it may perhaps have been allowed to rest too exclusively on such considerations ; and thus, under the influence of prejudice, or misconception, may have frequently encountered scepticism, where, had the argument been more enlarged, it would have carried conviction. Now, nothing appears more emphatically to demonstrate that Unity of the Body, on which Mr. Abernethy's principles are essentially based, than the consideration of the phenomena of Sympathy ; and to arrange some of the more important of these in a form which, if it do not challenge correctness, shall at least not disgust by its difficulty, has been my first object. In order to impress that linking together of individual existences, constituting the connexion of the whole with all its parts, I have endeavoured to shew that the mind furnishes its quota of illustration. I have also endeavoured to exemplify the bearings which the sympathies especially, have on the explanation of diseases; and in, not only establishing the excellence, but also in improving and enlarging the application of the constitutional treatment of them. In convi

PREFACE.

ducting the illustrations, there is no one sympathy of which twenty more manifestations might not have been mentioned ; but this, though very necessary in a work with no other object than a systematic account of the sympathies of the body, would be inconsistent with the design of this volume ; whilst, for the purposes of the argument, one fact, with regard to an individual sympathy, if it be indisputable, is as good as twenty. It may have happened, that I have not always made the most happy selection in the example of a given sympathy ; but I know not how this objection could have been certainly avoided ; because what appears very trite and demonstrative to one man, may not be so to another.

With the tabular view, which I have annexed at the end of the volume, will be (bund its requisite apology.

Last year, in an endeavour to correct some misconceptions which prevail with regard to the opinions of Mr. Abernethy, I added such arguments as a general view of the influence of the digestive organs seemed to furnish, to awaken a more lively

PREFACE.

vii and strict attention to the principles which it was my object to advocate. This discourse conchides the present vohime.

I may observe, that the " Remarks," &c. constituted some mtroductory lectures, and that they have been allowed to retain nearly their original form, with the exceptions of such breaks, or divisions, as seemed calculated to aid their perspicuity.

Argyll Place ^ Dec. 1835.

Chap. I. Page

Introduction of the subject I

Analytical examination recommended 10

CHAP. II. Manifestations of sympathy irregular 13

Common or general sympathy , 16

Of structural sympathy 18

mucous membranes 19

fibrous structures 20

bone 23

muscles 24

serous membranes 27

cellular tissue 28

absorbent glands 30

salivary glands 32

Of sympathy of mechanical relation 35

vensB portee, hoemorrhoids, heart, uterus, rectum, and

bladder 39

Of functional sympathy ^ 40

alimentary canal with its different portions 42

• and skin 43

skin and lungs 44

and kidney 45

and heart 46

of the skin with its several parts 49

heart and kidney 52

and lungs „ 53

b

X

INDEX.

liver and bowels 55

stomach and liver 56

nrethra and urinary organs 58

uterus and mammary glands 01

Chap. IV. Of Intermediate Sympathies

Stomach and lungs 65

Liver and lungs « 69

Stomach and kidney , 72

— and heart 74

and testicle . » 75

and uterus. 77

Uterus and kidney 80

Anomalous sympathies 80

Of the countenance 85

CHAP. V. Of the brain 90

Of the sympathy of the external senses with the body . . 92

of the external senses with each other. 94

external senses with the mind 99

Of the sympathy of the mind and body 103

Of reason and the passions 105

Of their sympathies with corporeal organs 105

CHAP. VI. Sympathy considered in its application to disease 118

Chiefly interesting to the surgeon 119

Consideration of sympathy establishes many facts .120

, assists us in understanding the

causation of disease 121

This remark considered 123

INDEX.

xi

The phenomena of catchmg cold considered .129

Explanation of them attempted 139

Circumstances influencing cutaneous susceptibility, or predisposing causes ; and why the digestive organs so extensively 139

Of sympathetic effects through organs primarily affected. loO

secondarily affected. 152

Of vapour bathing 154

Of local remedies as explicable by sympathy 156

Application of sympathy to treatment continued 165

Cases in illustration 1(>8

Application of sjanpathy in avoiding such frequent recourse to remedies which, notwithstanding the benefit which attends them, prove often ultimately

pernicious 185

Of the abuse of mercury — as producing diseases simulating syphilis, when the mercury has been given for

other affections — cases 19^

Unnecessary employment of powerful means not confined

to mercury 215

Of diseases of joints 222

Author not to be understood as recommending a practice

which merely ministers to symptoms 229

Discourse pursuing the argument as regards the digestive organs 237

Retrospective view of surgery 238

Sketch of Hunter and Abemetliy 239

Mr. Abernethy's views of life considered 248

misrepresentations of 250

Mr. Abernethy's views of disease 254

His views contended for and testified by diseases of all

periods of life 200

By a brief review of the anatomico-physiological relations

of the chylopoietic viscera 265 xii

INDEX.

Digestive organs not to be too exclusively considered, notwithstanding, in the treatment of diseases ...... .265

Exhortation to avoid the errors of even the greatest men. .274

Hospital and dispensary practice 280

Conclusion 281

Tabular view of sympathies 289

Postscript 294

ERRATA.

Page 5, for final, read secondary.

32, — accompaning, read accompanyino:.

43, — similar disorders, read dissimilar disorder'^.

— 62, ~ little bud, read little bird.

153j — that the extreme, read the extreme.

tertially, read tertiarily.

189, — by any easy, read by an easy.

— — 191 , — 'nore prevalent, read most prevalent. 19 1, — i forms ol'diseases, read forms of disease.

Chapter 1

Whether we study accidents, or diseases, or reflect on the means by which they are reheved, nothing appears more important, nothing more essential to Scientific Surgery, than a conviction of the perfect Unity of the Body — by which I mean, an enlarged view of the animal oeconomy, which, whilst it recognizes a multiplicity of organs, presenting a varied arrangement of comparatively few elements ; — -which, whilst it embraces a number of facts, infinitely modified in their relations to the whole body, and to each other, shall yet contemplate them as parts of a grand whole, as constituting one integral fabric, and combining in one object ; the life of the individual. This view of the subject lends the greatest interest to the progressing accumulations of experience and observation ;

B it explains the uses of facts so accumulated, in a manner most easy and most consonant with reason ; and most readily confers on us the power of applying them with promptitude, either to the preservation of health, to the correction of disease, or to its suspension, or amelioration, where correction is beyond our power.

To the surgeon, the labours of John Hunter owe their chief value to the force with which they inculcate this principle of study ; nor can the investigations of Mr. Abernethy, nor the hght which his genius threw on those of Mr. Hunter, be remembered with a more just gratitude, than when viewed as contributing so largely as they unquestionably did, to establish such views of the animal oeconomy. On a former occasion, I endeavoured, in correcting some misapprehensions which exist with regard to the opinions of Mr. Abernethy, to enforce this connexion of all the parts of the body with each other, by such illustrations as were afforded by a cursory consideration of the Digestive Organs* ; and also to

* See the concluding discourse of the volume.

explain how the opinions of Mr. Hunter and Mr. Abernethy, though commencing at different points, and taking different courses, ultimately met in an identity of conclusion.

In furtherance of this object, I mean the connexion of all parts with each other ; I wish now to direct your attention to those phenomena which, though inscrutable in their nature^ are very apparent in their operation ; which, like sentinels to the animal oeconomy, guard its portals from noxious influences, communicate alarm when they shall have gained admittance, or excite exertions for their expulsion. I wish to consider those laws which contribute so largely to our happiness, or misery, according as they operate in the harmony of health, or in that unbalancing of the functions which characterizes disease. It is to those mysterious links, in the chain of vital phenomena, Vv^hich constitute the sympathies of the body, that I claim your attention. It appears to me that their importance in the treatment of diseases is by no means duly appreciated ; that a more frequent and easy recurrence to the wide range of facts which they comprise is absolutely necessary ; and that the first step to this must be a closer and a more analytical examination than we have been accustomed to afford them.

If medico-philosophical enquiry present no subject more hnportant or interesting ; none having more direct bearings on the treatment of disease ; it is equally true that it furnishes none more difficult.

Its difficulties render enquiry laborious and ungrateful ; its doubts, with nothing decided but their infinity, repress the desire for investigation. Were we discouraged, however, by difficulty, knowledge would no longer be progressive, and we should be deprived of many unfading sources of enjoyment, not only the highest as being most intellectual, but the best as being most pure.

Let us rather strive to make the difficulties themselves our coadjutors ; let them teach us that circumspection in enquiry which examines every part of a subject, without being aUured by the more prominent or seductive points of it. Let them induce a ceaseless caution in our conclusions. Let them, in impressing on us the finite nature of our faculties, induce an humbleness of mind, which, if it does not always conduct us to the sanctuary of truth, at least teaches us to avoid the fastnesses of prejudice ; diffuses a calmness and serenity through the mind most favourable to mental exertion ; and preserves us from disappointment, when we find how limited those results prove, which are alone within the reach of our measured perceptions.

Though the final causes of things be concealed from us, as probably neither adapted to our present capacity nor our happiness ; yet, so far as the progress of knowledge has hitherto enabled us to judge, it would appear, that those facts, which are really useful to us, lie well open to investigation, and are easily appreciable by the human understanding. It would also seem, that there is scarcely any part of our knowledge, however recondite, of which some type — shall I say suggestion ? — has not been presented on the very surface of nature. We know not the nature of light, still less of the instrument by which the Creator puts it in such rapid motion ; but a thousand phenomena, of daily occurrence, illustrate its laws ; nay, even its composite nature, a comparatively recent discovery, has always been exemplified in a phenomenon no less striking than the rainbow. How strange it seems to us, when we consider such matters for the first time, that the principal agents in nature should be invisible ! as electricity, galvanism ; or that so much of matter, should be resolvable into invisible gases ; yet we find a type of this in the very air we breathe ; the substantial nature of which, if not suggested by respiration, is pleasingly disclosed to us in the fanning of the breeze, or strikingly demonstrated in the sweeping of the tempest.

It appears to have required the mind of a Newton, to have proved, by mathematical, the most approved method of human ratiocination, that the hexagonal form of the bee-cell was actually the best possible for

(^economy of space*. Every bee-hive, however, shewed its beautiful and successful adaptation to the adjustment of thousands in a very small space ; who, next to their number and industry, were so distinguished for the order of an apparently crowded community, as to have furnished its most interesting example to man in all ages ; an illustration as simple and remarkable, as the proof of the principle of the rule might be difficult ; and which would suggest to the natural theologian the same conclusion which Newton's calculus would demonstrate to the mathematician.

Numerous similar illustrations of the valuable parts of subjects, lying near the surface, might be adduced. Let us hope that this may ultimately prove the case with regard to the sympathies of the body. Mr. Hunter was strongly impressed with

* How strikingly does this suggest that limited reliance on our own senses which I cannot but think is too often overlooked hy anatomical investigators, and that (as Mr. Aberneth j used to observe) many things, though not perceivable by our senses, are not the less demonstrable to reason.

their importance, and laboured hard, if not to explain their nature, at least to mark their operation. Mr. Abernethy, who heard Mr. Hunter's lectures, used to say, with the quick perception, or, if you please, with the characteristic impatience of genius, that Mr. Hunter, at last, only proved that the whole, sympathized with all its parts. This, no doubt, expressed the result and intention of Mr. Hunter's endeavours ; but it may reasonably be said, that a more analytical treatment of such a subject, especially in the hands of Mr. Abernethy, would have much enlarged the utility of Mr. Hunter's discourses ; have impressed the facts much more strongly on the mind, and have more clearly unfolded the influence of this sympathy, in the derangement of health, and in the treatment of disease.

The analytical examination of the grounds on which a fact rests, not only tends to strengthen our belief in it, but is necessary, if we require conviction. It is a kind of intellectual chemistry, which, resolving a fact into its constituent principles, discloses the extent, variety, and importance, of its application. It reveals to lis numerous phenomena, no more suggested by the ultimate fact which they tend to establish, than the homogeneous appearance of many compounds, suggests their complicated elements. To know the strength of a chain, we must be convinced of its unity ; and this we only effect by examining the Hnks of which it is composed.

Conviction, thus obtained, (to say nothing of the useful views frequently arising in its progress) is emphatically our own ; the mind, recognizing it as such, applies it with promptitude, almost without an effort, to the purposes it may be designed to serve. Compared to faith, however unreserved, on the dicta of another, it is the inductive result of the highest intellectual operation, contrasted with a blind confidence in authority, in which reason has commonly little or no share. No one can doubt that Mr. Hunter entertained such views : it is certain he treated the subject in the way they would recommend ; viz. by an examination in detail.

It cannot, perhaps, be denied, that anatomy has fornished some assistance in enquiring into the phenomena of Sympathy ; but it is to be feared that more has been expected from it than it is capable of supplying ; whilst, by engrossing too exclusive an attention, it may sometimes have closed more enlarged, and perhaps more promising, avenues for investigation. In pointing out universal nervous communications, it suggests, a priori, the functional integrity of the body ; in shewing identical tissues, arranged in different situations, and, in assisting our physiological conclusions as to individual organs, it facilitates the classification of phenomena ; applied to the explanation of individual sympathies, it affords us little help : if it occasionally hold out promise in this way, it is but to allure us to disappointment.

The consideration of the eighth pair of nerves and itls communications with the branches of the cervical gangha of the sympathetic, and the sympathies of certain parts to which these are distributed; and the inadequacy of any apphcation, I may say the absence of analogous facts, when we consider other sympathies no less remarkable, the uterus and stomach, for example, — illustrate this remark.

We do not indeed expect anatomy to assist us in explaining the most marked sympathy of all ; namely, that between mind and body ; but its failure here is but typical of its incompetency to explain many corporeal phenomena. We shall probably obtain more advantage from a careful observation and notation of the phenomena which are daily unfolded to us ; of the circumstances by which they are preceded, accompanied, or followed ; and, when our facts shall have become multiplied, by examining how far we can establish that coexistence or sequence of any of them, which shall suggest the idea of a law, in the mode of their production. At present, we can be said to know scarcely anything of the laws of sympathy. They exercise a momentous influence, and generally of a salutary tendency. If they sometimes contribute to our decline, they but remind us that death, as well as life, is a law of our nature.

Chapter II

In contemplating the sympathies of the body, it is more easy to make a convenient arrangement than a scientific classification.

Sympathetic actions are sometimes similar to the primary impressions ; sometimes not*. Affections of the absorbent glands are sometimes similar to those whicli produce them ; sometimes, common irritation. When o:onorrhoea affects the eve, the action induced is similar ; when it affects the testes, it is not so.

Sympathy is sometimes reciprocal ; as in the head and stomach, stomach and bowels, or skin and kidney : at other times it appears to act chiefly in one direction ;

* See J. Hunter ; Reminiscences, Art. Sympathy.

as when the testicle sympathizes with the urethra, or the stomach with the testicle. These are common occurrences. But it is seldom that we see the testicle sympathizing with the stomach, or the urethra with the testicle.

Sometimes, sympathetic actions are more prominent than the primary impressions ; as when the head sympathizes with the stomach or liver ; or the knee in incipient diseases of the hip ; or the shoulder with the liver : at other times, less so ; as in many irregularities of function in the kidney, either in dyspepsia, or disordered bowels.

Sometimes, they appear to have a reference to the properties, whether functional or organic, of the parts between which they occur ; as in the heart and lungs ; or in mucous membranes : sometimes, they have no such reference ; as in the uterus and stomach, or testicle and parotid glands.

Sometimes, they appear in relation to continuity of surface ; as in the skin, peritonaeum, or urethra ; or contiguity of position, as bladder and rectum ; or to other mechanical relations ; as those of the vena portge and hsemorrlioidal veins: sometimes, without any such relation, as in the sympathy of the stomach and kidney. On the other hand, these relations sometimes exist, without any manifestation of sympathy ; as in the contiguity of muscles and absorbent glands, or the mechanical relations of the thyroid gland and larynx. The larynx sympathizes very little with the thyroid gland, unless this be changed in structure. Bronchocele, which is merely an enlargement of the natural structure of the thyroid, seldom produces any affection of the larynx, unless it be from its weight and pressure. There is an example of the absence of any sympathy of the larynx in a patient now in the Dispensary. She is a young woman, aged 18, a native of Buckinghamshire. The bronchocele measures, in its transverse diameter, 13| inches ; its circumference measures two feet, less three quarters of an inch.

The modes in which sympathetic actions are manifested are indefinitely modified, as regards the parts between which they are developed, in different persons ; or at different times in the same individual ; either as the result of natural peculiarity, or that, consequent on disease. A large volume would scarcely afford space for a full discussion of this extensive subject : I need not say that it is impossible to accomplish it in the limits which various considerations have induced me to prescribe to these observations.

It appears convenient, in the first place, to divide sympathy into common, and proper ; general or particular : and, having ex plained the former of these terms, to make such subdivisions of the latter, as shall appear necessary.

By common or general sympathy, I mean that sympathy of the whole with all its parts, demonstrated by the multiform and interesting phenomena, usually included in the term constitutional irritation. A sympathy, peculiar to no organ, but common to every structure in the body ; seen alike in primary affections of the nervous, respiratory, and circulating systems ; the whole of the chylo-poietic viscera, the urinary and generative organs ; in glandular structures, whether absorbino; or secretino; organs ; in skin, muscle, bone, tendons, ligament, cartilage, and in the cellular tissue, whether this be expanded into sheets of membrane, or employed in the more common office, as a connecting medium ; a sympathy which, though more marked in some instances than others, as in the effects of teething, and in symptomatic fever, is nevertheless seen, in greater or less degree, in almost every malady presented to the physician or surgeon. The great example of that unity to which all the sympathies contribute, it is as it were the focal centre around which these sympathies revolve, and the point in which their converging influences meet for the preservation of the body ; a chain connecting all parts by the particular or individual sympathies, some of which we are next to examine.

First, then, we will divide these, as they appear to be more or less influenced by the circumstances which the terms imply ; into the structural, functional, and intermediate : sympathies of mechanical relation ; sympathy of absorbent glands ; anomalous sympathies ; sympathies of idiosyncrasy. These divisions will probably be sufficient for our

c purpose. The illustrations will necessarily be brief, and, for obvious reasons, as trite as possible.

STRUCTURAL DIVISION,

Including parts presenting either identity or analogy of structure.

The parts which seem most conveniently to range themselves in this division, are the mucous, serous, and fibrous membranes, fibrous structures generally, muscles, bones, the apparatus of joints, and cellular tissue.

Mucous Membranes,

The mucous membranes present the largest surface in the body, the skin only excepted, of which indeed they appear but a modified involution. Their sympathies are marked and important, and, in relation to the skin especially (as will hereafter be explained), exert a very extensive influence in the production of the diseases of this climate.

The sympathy of mucous membranes with each other is seen in the various affections of the stomach, producing disorders of other portions of the ahmentary canal, or vice versa ; or in the same reciprocity of sympathy exemphfied in the mouth, nose, fauces, trachea, and bronchial ramifications, and stomach ; in the sympathy of the urethra and bladder ; or in the conjunctiva of the eye with the urethra, in various cases of gonorrhoeal ophthalmia, and other minor affections of a similar kind, but not falling under that designation. Irritation of the alimentary canal from worms, or otherwise, will produce irritation in the nose ; or irritation applied to the nose, especially that resulting from snuff, will affect the alimentary canal.

The sympathies of the mucous membranes with the skin are equally important. They are displayed in affections of the stomach, bowels, lungs, and urinary organs ; and are reciprocal, appearing in a manner equally marked, whether the impressions on these organs be primary ; or secondary, as from cold. The sympathy of the mucous c 2 membranes of the alimentary canal and skin is further seen in the whole of the diseases of the skin, which, for the most part, are but examples of such sympathy.

Fibrous Structures^

Such as the dura mater, pericardium, periosteum, ligaments, tendon, &c. have marked sympathies with each other ; and frequently exemplify, in their readiness to sympathize with general disturbance, a remark of Mr. Abernethy's ; viz. that parts most disposed to suffer, under such circumstances, were those either possessing " least life, or most susceptibility." The sympathy of these parts with each other, and with the skin, is best exemplified in many instances of a common cold, and in the phenomena of rheumatism ; with the skin, in the disorder frequently impressed through that organ, and frequently immediately subjacent to the part on which the cold has been applied ; with each other, in the frequent metastasis of most of their affections, (rheumatism more especially): from one joint to another, or from a joint to some fibrous membrane, even that of the heart itself. In the fasciae, both in their proneness to sympathize with similar structures, as joints, as well as to be primarily affected by the same impressions, as cold.

A case occurred, about four years ago, of a very severe inflammation of the fascia of the thigh, ultimately involving the femoral vein, which, from its general interest, I think worth relation. A poor boy, not very well clad, was sitting on a gate on a cold day, and he felt the wind blow on his thigh, which was quickly followed by a very acute pain in the same situation. He immediately went home, which he reached with difficulty ; and on the second day his parents applied at the Dispensary. On examining his thigh, it was neither red nor swollen, or very little, but extremely painful, and exquisitely tender on the slightest pressure. I told the gentlemen who accompanied me that I regarded it as inflammation of the fascia. His health was much disordered, and his pulse indicated excitement with want of power. Leeches were freely applied to the part, with fomentations and poultices ; and he was seen again the next day. The limb was now swollen, but not discoloured, excessively painful, and exhibited an appearance which led me to remark, that had it been in a woman recently parturient, it would be called phlegmasia dolens. The treatment consisted of further local depletion and mercury ; but the rapidly increasing depression of the system, which had been observed from the first, obliged us to relinquish the plan, and endeavour to support him by such means as seem likely not to produce excitement. Notwithstanding the most sedulous attention to the conflicting indications, he gradually sank. Examination discovered a very considerable thickening of the fascia of the thigh, and of the cellular tissue : a moderate quantity of pus lay around and in the course of the femoral vein, which, on being laid open, was found also to contain pus, with considerable depositions of coagulable lymph.

Another case, in all respects similar, occurred about a year after the preceding ;

but, as indisposition prevented me from seeing the case more than twice, I am indebted to Mr. Wright, an inteUigent pupil, who had the care of the case, for the following particulars : — He does not remember that the exact cause was ascertained : the treatment was the same as in the former case, at first ; and, subsequently thereto, was directed to the regulation of his diet, and the alvine secretions. This boy recovered.

Rheumatism and colds also illustrate the sympathies which exist between the fibrous and mucous structures ; they are seen in the disordered secretions of the latter, which, from some surface or other, so constantly attend disordered affections of fibrous structures originating in cold. Nothing, however, more strikingly demonstrates the sympathy of mucous and fibrous structures, than the phenomena of stricture, and what has been called Gonorrhoeal Rheumatism.