the causes which may have given rise to the steatome, but we think it is not important to mention them. There are three engravings at the end of the dissertation, which furnish a very correct idea of the tumour. THE MEDICAL DOCTRINES AND PRACTICE OF M. BROUSSAIS OF VAL DE GRACE*. THE doctrines and practice of Broussais, which are at present creating so much discussion in France, appear to be an illegiti-mate branch of the Italian school, founded by Rasori, Borda, and Tommassini. Illegitimate we call them, in so far as Broussais, if we mistake not, does not acknowledge the source whence he derived his views; but, on the contrary, by means of new terms, or of old terms with new meanings, he has so masked and disguised his details, that even the tritest common places of the science assume in his hands an air of novelty. This is much promoted by the increasing neglect of the present generation for the old authors, and the eager desire for what is new; and it is much to be regretted, though we see not how it can be remedied, that the flimsiest production, if new, will be keenly devoured, while the works of Sydenham, Cullen, Hunter, Morgagni, and Bichât, are seldom to be seen out of the shelves of a library. Broussais, however, with all his pretensions to originality, and his censorious remarks on his professional brethren, must confess his obligations to his Italian masters, who, indeed, expressly claim him as a disciple of their school-(TOMMASSINI, Dell' Infiammizione e della Febbre.) It is singular enough that * Histoire des Phlegmasies, ou Inflammations Chroniques, fondées sur de Nouvelles Observations de Clinique, et d'Anatomie Pathologique. 8vo. Edit. Sme Paris, 1822. Et. Examen des Doctrines Médicales et des Systèmes de Nosologie, &c. précédé de Propositions renfermant la Substance de la Médecine Physiologique. Par F.J. V. Broussais, D. M. &c. &c. 8vo. Paris, 1821. Leçons du Docteur Broussais, sur le Phlegmasies Gastriques, dites Fièvres continuès essentielles des Auteurs, et sur les Phlegmasies Cutanées Aigues. Par MM. E. de Caignou et A. Quemont. 8vo. Paris, 1819. Principes Généraux de Physiologie-pathologique, co-ordonnés d'après la Doctrine de M. Broussais. Par L. J. Begin. · 8vo. Paris, 1821. Défense des Médecins Français contre le Docteur Broussais. Par S. P. Authenac, in l'Ann. Bibl. Février. 1822. M. Broussais himself records distinctly the origin of his views, though he takes care to claim for himself the higher merit of systematizing them; that "Tommassini publici, dès 1805, que le caractère sthénique des maladies fébriles ne se borne pas aux premier jour. Dès-lors il soutint que la nature sthénique des maladies se conserve la même depuis le premier moment de l'invasion jusqu'au dernier degré de l'épuisement; que toutes les inflammations aiguës, chroniques, évidentes, obscures, sont de cette nature jusqu'à l'entier épuisement des forces, et qu'en un mot les phlegmasies, dont on rencontre les traces apres la mort, sont toujours la cause et jamais l'effet des fièvres qui ont existé durant la vie. La distinction des inflammations en sthéniques et en asthéniques fut donc regardée comme illusoire et purement spéculative."-(Examen des Doctr. Med.) We do not deny that M. Broussais has high merit, and that he has, by observation and dissection, done much to illustrate diseases; but we think he has himself made his merits appear less than they are, by his illiberal criticisms and his assuming pretensions. M. Broussais received the earlier part of his medical education in the Ecole de Médicine, during the commencement of the Revolution, the bustle of which was not very favourable to study; and, accordingly, when he arrived in the north of Italy with the corps of the French army to which he had been appointed, he found himself so deficient in the knowledge of his profession, that he very laudably put himself under the instructions of Rasori and Tommassini. The doctrines of contrastimulus had then scarcely been moulded into a system; but he learned enough to turn his attention from the system of Brown, then in its zenith on the Continent ;-and in the very extensive experience which he afterwards had in the campaigns of Napoleon, he kept the Italian principles constantly in view, but contrived a vocabulary of his own for expressing them. This, however, he did very gradually; for, on comparing his early publications with his "Examen des Doctrines Medicales," published last year, we find almost nothing in common. M. Broussais, indeed, appears not to have had the most distant idea of forming a school, till the honour was actually thrust upon him in the French journals. But his ambition was easily kindled, and he instantly stood forward to assume the profered honour, and vindicate his claims to originality, by attacking all that was established and venerable in the profession, from Hippocrates to Dr. Wilson Philip, together with "la Médecine Française en general." As we wish not to extend this paper, we shall give a brief view of some of the doctrines of this innovator, and the practice founded on them. M. Begin thinks it requisite to give formality to the system, by commencing with definitions of the vital properties, and the varieties of organization as to temperament and idiosyncrasy; but in all this we find nothing very peculiar, and much of common place. All that is really good seems to be borrowed, without acknowledgment, from Cabanis, (Rapports Physiques et Morales,) who, by the way, is unsparingly reprobated by Broussais. As it is thought the chief peculiarities of the school of Val de Grace are in the views given of inflammation and fever, we shall confine our notice principally to these. INFLAMMATION, according to M. Broussais, may be of three kinds : Inflammation affecting, 1st, the red capillary vessels ; 28, the white capillary vessels; and 3d, both the red and the white capillary vessels. In the first variety, when irritation caused by a stimulus has affected any of the organs or of the tissues with acute inflammation of the sanguineous capillaries, the part affected becomes converted into a red mass, of a density and volume proportioned to circumstances. The violence of the pain and deepness of the colour are also variable, and from variety of causes and constitution it runs a variable course. It may, for example, gradually disappear by the vessels regaining their natural fulness, and by the superabundant blood being naturally distributed, or carried off by some critical discharge either of blood or of the fluids derived from it. These critical discharges have been observed from the time of Hippocrates, and serve as very important guides to the medical practitioner. There may in this way be critical diarrhoea; critical epistaxis; critical hæmorrhoids; critical perspiration, which is perhaps the most common; and critical discharges of urine; and sometimes even critical menorrhoea. When this resolution of the inflammation commences, the part inflamed becomes less hard and unyielding to the touch; the throbbing pain subsides; the high colour disappears; and the integuments resume their healthy appearance, frequently without leaving the least hardness or elevation, or any adhesion in the cellular membrane, which the nicest dissection can trace. This however is not always the case; for adhesions very frequently do occur, though no change has otherwise ensued in the structure of the membrane. When the affection is chiefly in the skin, it terminates by desquamating; when in the mucous membranes, after copious discharge of serous matter, which gradually becomes thick and of a purulent appearance, the mem brane either resumes its natural state or ulcerates; when in the fibrous structure, a thickening of the parts is produced which after a time disappears. If the inflamed part returns not to a healthy state by resolution, it will either suppurate or become gangrenous. In the FIRST of these, which can only occur in expansible structures of the serous or cellular sort, the irritation is not limited to the capillary vessels carrying red blood. If it did, the inflammation could not continue so long as we often find it to do without producing pus, nor would the cellular and serous structures be capable of secreting pus without the symptoms of previous inflammation. Even when the suppurative process seems to be going on from inflammation of the sanguineous capillaries, it does not necessarily follow that they must secrete pus; for in the case of setons and of wounds and ulcers, the secretion of pus sometimes stops, though the redness and other marks of inflammation continue to exist. M. Broussais infers that suppuration is not necessary, but contingent to such inflammation; for pus may be secreted without this taking place, as is proved every day by dissection in cases where though pus has been copiously and long secreted and expectorated, yet no trace of suppuration nor ulceration can be found after death. Inflammation then often becomes chronic from being kept up by the pus. In the second case, the inflamed parts are entirely destroyed, and become, in respect to the body, dead; or, as it is medically termed, GANGRENOUS. This may arise from several causes, such as, when morbid poisons destroy the parts, in plague, small-pox, &c.; when the increasing weakness of the vessels leads to the death of the parts which they nourish; or when the vessels are overpowered or burst by excess of inflammation, or a more rapid flow of blood than they can sustain. This is illustrated by referring to gangrene of the lungs, which is exceedingly rare, and must be so from the circumstance, that death usually supervenes before gangrene can take place, the lungs being so essential to the life of the system. When inflammation does terminate in gangrene of the lungs, only one of the lungs can become gangrenous, for both could not be so without instantly extinguishing life. When inflammation does not terminate by resolution, suppuration, or gangrene, it assumes a prolonged and CHRONIC character. It is in the elucidating of this species of inflammation, that M. Broussais has been so much praised. It does not occur in all the structures of the system, though we have not discovered any specification of those not liable to it. When the red capillary vessels only are affected, the effect is a permanent hardening of the parts affected, such as an hepatic state of the lungs, callosity in the cutis, and a thickening and induration of the mucous membranes. On the other hand, when the affection extends to the other capillaries, pus will be produced in the cellular structure, and in this case it will, like power, become the instrument of its own propagation, from the retention and decomposition of the pus giving rise to irritation. According indeed to the part affected, this kind of inflammation may produce tubercles, indurations, ulcers, pustules, tetters, vesicles, and even scrofula, malignant fungus, and scirrhus. In all this, however, there appears to us little novelty, and in what follows concerning the other species of inflammation, characterised by the disorder occurring in the white capillaries only, there seems to be a great deal of unnecessary division and subdivision, and minuteness of detail founded more on a systematic plan than on accurate observation. Although arrangements of this kind are unquestionably of high utility, yet as they are all artificial, and tend to give us false views of facts, we are always very suspicious of them when they are carried, as in the present instance, to the extreme of minuteness. They do indeed give a work or a system a philosophical aspect, and an imposing appearance of accuracy; but this will in most cases tend more to acquire fame for the author than to give information to the reader, who will look in vain for his fine distinctions at the patient's bedside. We shall next give a brief sketch of M. Broussais' doctrine of FEVER*. In the long list of afflictions to which the human system is liable, there are none which have so often abstracted the attention of medical men, as the various forms of fever. Ever since medicine had the rank of a science, this very formidable class of diseases has been the source of discussions and investigations, as boundless as they are vague and illusory. If we consult the history of medicine, even at its remotest periods, it will be found that each century gave rise to new doctrines, each promulgated with the plausible intention of explaining obscure phenomena, and adding to our mass of information; but neither of which, notwithstanding the authority of profound erudition and great names, have as yet dispelled the cloud that hangs over this intricate subject. Unfortunately for humanity, no other series of affections affords so extensive a range for speculation: unfortunately, because with such a field before them, many have leaped into the arena, with no other weapons for scientific con → CHAPMAN'S Journal, Vol. III. p. 345. |