Edward Barlow

“ The sarcasm of the reviewer, as applied to the general profession, I believe to be unmerited: and if merited, it would still be unjust, inasmuch as the blame would lie not with them, but in the public ignorance of all physiological knowledge, and also in the political constitution of their own department, which makes no provision for distinguishing those whom the profession itself would delight to honour. The highest honours of physic are allotted not by superiority of merit, but by accident of education, and consequently collegiate rank is no measure of talents or acquirements ”

“ It is, at length, full time, in profiting by the good, to avoid the evil. Reference to nosology is of use, in directing attention promptly to the more important lesions, so as to ascertain what organs or functions are principally suffering. But much more is required even when this point is decided. The only mode practically valuable of scrutinizing an individual disease is, not to aim at identifying it with the nosological exemplar, but to ascertain the several functions actually depraved, making health the standard by which to judge of the nature and extent of the respective derangements. ”

“ Even medical men themselves, are, in general, equally careless and incompetent judges as the public at large, of all high accomplishments in their profession. Medicine they cultivate not as a science, but a trade; are indifferent to all that transcends the sphere of vulgar practice, and affect to despise what they are unable to appreciate.” Let us hope that the latter part of this pasquinade only shews the ignorance of the reviewer, and that it does not truly characterize the profession. ”

“ As an art, guided in its exercise by the principles which science supplies, physic is a noble vocation, calling forth the highest powers of the intellect, the purest emotions of the heart, and all who feel interested in its reputation, must be gratified and elevated in reflecting that, as such is it at the present day, cultivated by a body of practitioners who may vie with any other class of the community in sound judgment, extensive cultivation, varied knowledge, liberal principles, and active benevolence. ”

“ The standard of force, by which most people judge of a healthy pulse, is much too high. The pulse of real health is singularly calm, soft, equal, compressible, conveying no impression of a stream labouring in its course, nor of an energetic propelling power. Many misconceive it as a pulse of debility, and, on the slightest indisposition, enjoin, on this ground alone, more nutritive diet, wine, and stimulants, in order to restore that vigour in which they deem the pulse deficient, quaintly assuring the parties that they are a cup too low. ”

“ But, if the reproach thus cast by the reviewer attach at all to the profession so generally as is asserted, the fault would still lie not with the profession, but with those who, by upholding ignorance and impudence, confound all distinctions, and take from merit its legitimate encouragement and support. The utter incapability of the public to form any just estimate of medical talent, acts as a positive discouragement to all laborious and enlightened research ”

“ It can hardly be but that the modes of investigating disease ordinarily followed, labour under some radical errors or defects, else the researches of ages, pursued, as they have been, with exemplary diligence, and, in many splendid instances, by minds of the first order of intellect, must, ere this, have rendered our knowledge of the nature and treatment of disease more certain and more complete. ”

“ This kind of knowledge, too, is the staple of all works known by the name of Practice of Physic, than which none can be less satisfactory for consulting when difficulties occur, for although they exhibit, even to redundancy, means by which cures have been effected, they fail to display, sufficiently for guiding the practitioner, the grounds on which a choice should be made, or the minute observances essential for administering any remedy with effect. Such knowledge as they impart, is, no doubt, useful and necessary, but it furnishes no certain guidance. ”

“ It is ignorance only that can be thus misled; and, unhappily, this ignorance in all that regards the well-being of the body, and the maintenance or restoration of health, pervades all classes of the community to the highest. ”

“ Facts, then, being the foundation of medical science, the first requisite in all attempts to improve it, is to ensure all alleged facts being real truths. Medical facts are principally derived from the observation of phenomena during life, and the examination of structure after death. In both, many sources of fallacy exist, against which the medical enquirer should be on his guard. It will be convenient to consider, in the first place, those which regard the latter subject.
No facts in medicine are relied on with more confidence than those which dissection displays. ”

“ Owing to the imperfect state of our knowledge, the treatment of disease ordinarily pursued by judicious practitioners, partakes of both kinds; it is rational so far as the curative effect is sought through a primary influence on some or other of the natural functions followed by consecutive changes thence resulting; empirical, when from obscurity in the modus operandi, and failure in discerning the series of vital actions through which the cure takes place, this the ultimate effect can be alone perceived. ”

“ Medical observation is ever incomplete, unless it take cognizance of all the functions, the aggregate adequateness of which, respectively ascertained, constitutes and is essential to health. The state of each should be accurately examined, however unconnected it may appear to be with the prominent derangement. Diligent scrutiny will often detect a morbid condition where it was unsuspected; and a negative should never rest on surmise wherever direct evidence is attainable. ”

“ Regarded as a mere trade, the practice of physic requires but little skill, the qualities best suited for ensuring a prosperous career having no necessary connexion with intellect or science; an imposing manner, confident pretension, verbose declamation, interlarded with high-sounding terms, no matter how unintelligible or unmeaning; unhesitating assurances of cure; condemnation of whatever antecedent practitioners had done; these, and various other still less worthy arts, will suffice to gain a reputation sufficient to satisfy the cupidity of whoever can descend so low as to resort to them. ”

“ A state of health requires a calm pulse, temperate skin, clean and moist tongue, a clear head, tranquil respiration, natural appetite with digestion unconsciously performed, regular bowels, all the several secretions and excretions in adequate quantity and of natural character, and, finally, sound repose. If, in any of these respects, material deviation be discoverable, then, however unconscious the party may be of the existing derangement, health is so far impaired, and more determinate disease will sooner or later be sure to ensue. ”

“ It is clear that, if, in the operation of remedies which, through our ignorance, we are compelled to use empirically, we could discover the series of physiological changes through which the curative effect is produced, our knowledge would be most valuably extended, and our capability of administering such remedies with precision and certainty, be greatly increased. ”

“ He soon finds that the nosological character of disease is seldom, if ever, realised in any individual case. However well marked this may be in its leading features, it is characterised by others of which his nosology takes no count. Many instances, and of formidable disease, will he meet with, which cannot be referred to any nosological character; and, if he be ambitious of noting all his cases, according to nosological arrangement, precision, in this respect, must be continually purchased at the expense of truth. ”

“ Florid looks, energy of frame, buoyancy of spirits, are no criterion, and may be deceptive, for all these may co-exist for a time with a state of constitution, which, if not amounting to disease, is fast approaching it; a deeper scrutiny is necessary for verifying the alleged health which such persons are supposed to enjoy. ”

“ Yet, in this respect, the prevailing notions are much less correct than they ought to be, and numbers are daily regarded as in perfect health, who, on a very slight examination, would shew evidences of such derangement of function, as only awaited an adequate exciting cause to be aroused into disease of the most intense activity. The habit too much obtains of ascribing the degree of severity of disease to the activity of the exciting cause. Much more truly would it be imputed to the state of constitution to which the exciting cause is applied. ”

“ The pulse, which is the principal index of the sufficiency of the nutritive matter imbibed into the system, and of the powers by which it is appropriated to the purposes of the economy, continually misleads; so prevalent is redundancy of blood, and the energetic circulation to which it gives rise, that a pulse of perfect health is rarely met with. ”

“ There is reason to believe that functional disturbance alone of the kidneys may produce albuminous urine. These cases are inflammatory; the albumen is much more abundant than in those noticed by Dr. Bright; it varies with the progress of the disease, and disappears as this retires. In the progress of treatment, too, it furnishes valuable guidance for the due administration of remedies, such as no other indications yield. The object of treatment in all diseases, is to excite the constitutional powers to sanative efforts, just so far as is necessary for remedying the existing derangement. ”

“ In examining the brain, the practice of slicing should be for ever abandoned. As this rude and in artificial mode is utterly incapable of displaying the natural structure of the organ, so is it unfitted for demonstrating those lesions which disease induces. ”

“ In determining the treatment of diseases, no mode can have less to recommend it than that which adapts the remedy according to the name of the disease. And yet it is very prevalent; even intelligent practitioners being sedulous to ascertain from medical records, what course of treatment has most generally succeeded, in order to apply it in some particular instance. ”

“ The scrutiny of an individual malady can never be complete when it only commences with a stage of disease already advanced; and the employment of remedies must ever fail in precision, and can make but slow progress towards the perfection attainable, so long as the mode obtains of first judging the disease by its correspondence with a nosological character, and then applying to it the means which have proved serviceable in the larger proportion of similar cases. ”

“ This knowledge must be sought through a closer investigation of those vital processes by which nature, when duly assisted, can accomplish so much in rectifying the derangements of the animal frame. It will not be denied that many such operations of nature, which at present lie hid, are capable of being discovered; and, if so, the medical enquirer can hardly pursue any research more useful or interesting than that of exploring them. ”

“ Adequate stools, with healthy intestinal secretions, are necessary at all times. They become doubly so whenever the general health is disturbed, or disease of any kind has occurred. A large proportion of disease presents more or less of a febrile character. In all such, the intestinal secretions become first increased, then vitiated. This vitiated matter accumulates, inflicting a two-fold injury, both obstructing the secerning vessels in the exercise of their functions, and acting itself as an irritant in producing or aggravating manifold distant disturbances. ”

“ While the association embraces in its designs the whole range of medical science, it is to the improvement and diffusion of practical knowledge its efforts will be more especially directed, this being the great end for which the science exists. ”

“ It continually occurs, though the fact seems not to have been noticed, that a thin but firm buff, of a pink colour, presents, on slight inspection, an appearance as if no buff were formed. The shades of colour vary, yet are all such as to convey to those who are unaware of the fact, the impression of there being no buff. ”

“ In all organized living matter, three great fundamental actions are uninterruptedly going forward, namely, capillary circulation, nutrition, and secretion. In man, and in those animals occupying a place near him in the zoological scale, a fourth action, derived from the nervous system, is superadded, which exercises a powerful influence and control over the others. ”

“ Should such a person be suddenly seized with some acute distemper, from exposure to an exciting cause, it is obvious that the antecedent state of general health must have material influence on the superinduced disease. Depravation of other functions may also escape notice, if appearances be relied on, or superficial examination trusted to. The brain may be overcharged with blood, giving rise to casual languor, drowsiness, heavy sleep; the heart and lungs may labour from slight bodily exertion; the stomach may feel oppressed by food ”