Thus much, as to what was effected by the Scotch in the department of inorganic science. If we now turn to organic science, we shall find that, there also, their labours were very remarkable. To those who are capable of a certain elevation and compass of thought, it will appear, in the highest degree, probable, that, between the organic and inorganic world, there is no real difference. That they are separated, as is commonly asserted, by a sharp line of demarcation, which indicates where one abruptly ends, and the other abruptly begins, seems to be a supposition altogether untenable. Nature does not pause, and break off in this fitful and irregular manner. In her works there is neither gap nor chasm. To a really scientific mind, the material world presents one vast and uninterrupted series, gradually rising from the lowest to the highest forms, but never stopping. In one part of that series, we find a particular structure, which, so far as our observations have yet extended, we, in another part, cannot find. We also observe particular functions, which correspond to the structure, and, as we believe, result from it. This is all we know. Yet, from these scanty facts, we, who, at present, are still in the infancy of knowledge, and have but skimmed the surface of things, are expected to infer, that there must be a point, in the chain of existence, where both structure and function suddenly cease, and, after which, we may vainly search for signs of life. It would be difficult to conceive a conclusion more repugnant to the whole march and analogy of modern thought. In every department, the speculations of the greatest thinkers are constantly tending to coördinate all phenomena, and to regard them as different, indeed, in degree, but by no means as different in kind. Formerly, men were content to ground their conviction of this difference in kind, on the evidence of the eye, which, on a cursory inspection, saw an organization in some bodies, and not in others. From the organization, they inferred the life, and supposed that plants, for instance, had life, but that minerals had none. This sort of argument was long deemed satisfactory; but, in the course of time, it broke down; more evidence was required, and, since the middle of the seventeenth century, it has been universally admitted, that the eye, by itself, is an untrustworthy witness, and that we must employ the microscope, instead of relying on the unaided testimony of our own puny and precarious senses. But the microscope is steadily improving, and we cannot tell what limits there are to its capacity for improvement. Consequently, we cannot tell what fresh secrets it may disclose. Neither can we say, that it may not be altogether superseded by some new artificial resource, which shall furnish us with evidence, as superior to any yet supplied, as our present evidence is superior to that of the naked eye. Even already, and notwithstanding the shortness of time during which the microscope has been a really effective instrument, it has revealed to us organizations, the existence of which no one had previously suspected. It has proved, that what, for thousands of years, had been deemed mere specks of inert matter, are, in truth, animals possessing most of the functions which we possess, reproducing their species in regular and orderly succession, and endowed with a nervous system, which shows that they must be susceptible of pain and enjoyment. It has detected life hidden in the glaciers of Switzerland; it has found it embedded in the polar ice, and, if it can flourish there, it is hard to say from what quarter it can be shut out. So unwilling, however, are most men to relinquish old notions, that the resources of chemistry have been called in, to ascertain the supposed difference between organic and inorganic matter: it being asserted, that, in the organic world, there is a greater complexity of molecular combination, than in the inorganic.814 Chemists further assert, that, in organic nature, there is a predominance of carbon, and, in inorganic, a predominance of silicon.815 But chemical analysis, like microscopic observation, is making such rapid strides, that each generation, I had almost said each year, is unsettling some of the conclusions previously established; so that, now, and for a long time hence, we must regard those conclusions as empirical, and, indeed, as merely tentative. Surely a permanent and universal inference cannot be drawn from shifting and precarious facts, which are admitted to-day, and may be overthrown to-morrow. It would, therefore, appear that, in favour of the opinion, that some bodies are living, and that others are dead, we have nothing, except the circumstance, that our researches, so far as they have yet gone, have shown that cellular structure, growth, and reproduction, are not the invariable properties of matter, but are excluded from a large part of the visible world, which, on that account, we call inanimate. This is the whole of the argument on that side of the question. On the other side, we have the fact, that our sight, and the artificial instruments, by whose aid we have arrived at this conclusion, are confessedly imperfect; and we have the further fact, that, imperfect as they are, they have proved, that the organic kingdom is infinitely more extensive than the boldest dreamer had ever imagined, while they have not been able to enlarge the boundaries of the inorganic kingdom to any thing like the same amount. This shows, that, so far as our opinions are concerned, the balance is steadily inclining in one given direction; in other words, as our knowledge advances, a belief in the organic is encroaching upon a belief in the inorganic.816 When we, moreover, add, that all science is manifestly converging towards one simple and general theory, which shall cover the whole range of material phenomena, and that, at each successive step, some irregularities are explained away, and some inequalities are reduced, it can hardly be doubted, that such a movement tends to weaken those old distinctions, the reality of which has been too hastily assumed; and that, in their place, we must, sooner or later, substitute the more comprehensive view, that life is a property of all matter, and that the classification of bodies into animate and inanimate, or into organic and inorganic, is merely a provisional arrangement, convenient, perhaps, for our present purposes, but which, like all similar divisions, will eventually be merged in a higher and wider scheme.
Until, however, that step is taken, we must be content to reason according to the evidence supplied by our imperfect instruments, or by our still more imperfect senses. We, therefore, recognize the difference between organic and inorganic nature, not as a scientific truth, but as a scientific artifice, by which we separate in idea, what is inseparable in fact; hoping, in this way, to pursue our course with the greater ease, and ultimately to obtain results, which will make the artifice needless. Assuming, then, this division, we may refer all investigations of organic bodies to one of two objects. The first object is, to ascertain the law of those bodies, in their usual, healthy, or, as we somewhat erroneously phrase it, normal course. The other object is, to ascertain their law, in their unusual, unhealthy, or abnormal course. When we attempt to do the first of these things, we are physiologists. When we attempt to do the second, we are pathologists.817
Physiology and pathology are thus the two fundamental divisions of all organic science.818 Each is intimately connected with the other; and eventually, no doubt, both will be fused into a single study, by discovering laws which will prove that here, as elsewhere, nothing is really abnormal, or irregular. Hitherto, however, the physiologists have immeasurably outstripped the pathologists in the comprehensiveness of their views, and, therefore, in the value of their results. For, the best physiologists distinctly recognize that the basis of their science must include, not only the animals below man, but also the entire vegetable kingdom, and that, without this commanding survey of the whole realm of organic nature, we cannot possibly understand even human physiology, still less general physiology. The pathologists, on the other hand, are so much in arrear, that the diseases of the lower animals rarely form part of their plan; while the diseases of plants are almost entirely neglected, although it is certain that, until all these have been studied, and some steps taken to generalize them, every pathological conclusion will be eminently empirical, on account of the narrowness of the field from which it is collected.
The science of pathology being still so backward in the conception as well as in the execution, that even men of real ability believe that it can be raised from a mere study of the human frame, it will hardly be expected that the Scotch, notwithstanding the marvellous boldness of their speculations, should have been able, in the eighteenth century, to anticipate a method which the nineteenth century has yet to employ. But they produced two pathologists of great ability, and to whom we owe considerable obligations. These were, Cullen and John Hunter.819 Cullen was eminent only as a pathologist; but Hunter, whose fine and discursive genius took a much wider range, was great both in physiology and in pathology. A short account of their generalizations respecting organic science, will be a fitting sequel to the notices I have already given of what was done by their countrymen for inorganic science, during the same period. It will complete our survey of the Scotch intellect, and will enable the reader to form some idea of the brilliant achievements of that most remarkable people, who, contrary to the course of affairs in all other modern nations, have shown that scientific discoveries do not necessarily weaken superstition, and that it is possible for two hostile principles to flourish side by side, without ever coming into actual collision, or without sensibly impairing each other's vigour.
In 1751, Cullen was appointed professor of medicine in the University of Glasgow;820 from which, however, in 1756, he was removed to the University of Edinburgh,821 where he delivered those celebrated lectures, on which his fame now depends. During the early part of his career, he paid great attention to inorganic physics, and propounded some remarkable speculations, which are supposed to have suggested the theory of latent heat to Black, who was his pupil.822 But, to follow out those views, would have required a number of minute experiments, which it did not suit the habit of his mind to make. Having, therefore, put forth his ideas, he left them to germinate, and passed on to his arduous attempt to generalize the laws of disease as they are exhibited in the human frame. In the study of disease, the phenomena being more obscure and less amenable to experiment, there was greater latitude for speculation; hence, he could more easily indulge in that love of theory, which was his ruling passion, and with an extreme devotion to which he has been reproached.823 That the reproach is not altogether unjust, must, I think, be admitted, since we find him laying down the doctrine, that, inasmuch as, in the treatment of disease, theory could not be separated from practice, it was unimportant which came first.824 This was tantamount to saying, that a medical practitioner might allow his theories to control his observations; for it is certain that, in an immense majority of cases, men are so tenacious of the opinions they imbibe, that whatever, in any pursuit, first occupies their understanding, is likely to mould all that comes afterwards. In ordinary minds, associations of ideas, if firmly established, become indissoluble; and the power of separating them, and of arranging them in new combinations, is one of the rarest of our endowments. An average intellect, when once possessed by a theory, can hardly ever escape from it. Hence, in practical matters, theory should be feared, just as, in scientific matters, it should be cherished; because practical pursuits are chiefly engrossed by the lower class of minds, where associations and the force of prejudice are extremely strong, while scientific pursuits concern the higher class, where such prepossessions are comparatively weak, and where close associations are more easily severed. The most powerful intellects are most accustomed to new arrangements of thought, and are, therefore, most able to break up old ones. On them, belief sits lightly, because they well know how little evidence we have for many of even our oldest beliefs. But the average, or, as we must say, without meaning offence, the inferior, minds, are not disturbed by these refinements. Theories, which they have once heartily embraced, they can hardly ever get rid of, and they often dignify them with the name of essential truths, and resent every attack upon them as a personal injury. Having inherited such theories from their fathers, they regard them with a sort of filial piety, and cling to them as if they were some rich acquisition, which no one has a right to touch.
To this latter class, nearly all men belong, who are more engaged in practical pursuits than in speculative ones. Among them, are the ordinary practitioners, whether in medicine or in any other department, extremely few of whom are willing to break up trains of thought to which they are inured.825 Though they profess to despise theory, they are, in reality, enslaved by it. All that they can do, is to conceal their subjection, by terming their theory a necessary belief. It must, therefore, be deemed a remarkable proof of Cullen's love of deductive reasoning, that he, sagacious and clear-sighted as he was, should have supposed that, in so practical an art as medicine, theory could, with impunity, precede practice. For, it is most assuredly true, that, taking men in the average, their minds are so constructed, that it cannot precede it without controlling it. It is equally true, that such control must be hurtful. Even now, and notwithstanding the great steps which have been taken in morbid anatomy, in animal chemistry, and in the microscopic investigation both of the fluids and solids of the human frame, the treatment of disease is a question of art, far more than a question of science. What chiefly characterizes the most eminent physicians, and gives them their real superiority, is not so much the extent of their theoretical knowledge, – though that, too, is often considerable, – but it is that fine and delicate perception which they owe, partly to experience, and partly to a natural quickness in detecting analogies and differences which escape ordinary observers. The process which they follow, is one of rapid, and, in some degree, unconscious, induction. And this is the reason why the greatest physiologists and chemists, which the medical profession possesses, are not, as a matter of course, the best curers of disease. If medicine were a science, they would always be the best. But medicine, being still essentially an art, depends mainly upon qualities which each practitioner has to acquire for himself, and which no scientific theory can teach. The time for a general theory has not yet come, and probably many generations will have to elapse before it does come. To suppose, therefore, that a theory of disease should, as a matter of education, precede the treatment of disease, is not only practically dangerous, but logically false. With its practical danger I am not now concerned; but its logical aspect is a curious illustration of that passion for systematic and dialectic reasoning which characterized Scotland. It shows that Cullen, in his eagerness to argue from principles to facts, instead of from facts to principles, could, in the most important of all arts, recommend a method of procedure, for which even our knowledge is not ripe, but which, in his time, was so singularly rash and immature, that nothing can explain its adoption by a man of such vigorous understanding, except the circumstance of his living in a country in which that peculiar method reigned supreme.
It must, however, be admitted that Cullen wielded the method with great ability, especially in his application of it to the science of pathology, to which it was far better suited than to the art of therapeutics. For, we must always remember, that the science which investigates the laws of disease, is quite a different thing from the art which cures it. The science has a speculative interest, which is irrespective of all practical considerations, and which depends simply on the fact, that, when it is completed, it will explain the aberrations of the whole organic world. Pathology aims at ascertaining the causes which determine every departure from the natural type, whether of form or of function. Hence it is, that no one can take a comprehensive view of the actual state of knowledge, without studying the theoretic relations between pathology and other departments of inquiry. To do this, is the business, not of practical men, but of philosophers, properly so called. The philosophic pathologist is as different from the physician, as a jurist is different from an advocate, or as an agricultural chemist is different from a farmer, or as a political economist is different from a statesman, or as an astronomer, who generalizes the laws of the heavenly bodies, is different from a captain, who navigates his ship by a practical application of those laws. The two sets of functions may be united, and occasionally, though very rarely, they are, but there is no necessity for their being so. While, therefore, it would be absurdly presumptuous for an unprofessional person to pass judgment on the therapeutical system of Cullen, it is perfectly legitimate for any one, who has studied the theory of these matters, to examine his pathological system; because that, like all scientific systems, must be amenable to general considerations, which are to be taken, partly from the adjoining sciences, and partly from the universal logic of philosophic method.
It is from this latter, or logical, point of view, that Cullen's pathology is interesting for the purposes of the present chapter. The character of his investigations may be illustrated by saying, that his method in pathology is analogous to that which Adam Smith adopted at the same time, though in a very different field. Both were deductive; and both, before arguing deductively, suppressed some of the premisses from which they reasoned. That this suppression is the key to Adam Smith's method, and was an intentional part of his plan, I have already shown; as also that, in each of his two works, he supplied the premisses in which the other work was deficient. In this respect, he was far superior to Cullen. For, though Cullen, like Smith, began by mutilating his problem in order to solve it more readily, he, unlike Smith, did not see the necessity of instituting another and parallel inquiry, which should complete the scheme, by starting from the premisses that had been previously omitted.
What I have termed the mutilation of the problem, was effected by Cullen in the following manner. His object was, to generalize the phenomena of disease, as they are exhibited in the human frame; and it was obvious to him, as to every one else, that the human frame consists partly of solids and partly of fluids. The peculiarity of his pathology is, that he reasons almost entirely from the laws of the solids, and makes so little account of the fluids, that he will only allow them to be the indirect causes of disease, which, in a scientific view, are to be deemed strictly subordinate to the direct causes, as represented by the solid constituents of our body.826 This assumption, though false, was perfectly justifiable, since, by curtailing the problem, he simplified its study; just as Adam Smith, in his Wealth of Nations, simplified the study of human nature, by curtailing it of all its sympathy. But this most comprehensive thinker was careful, in his Theory of Moral Sentiments, to restore to human nature the quality of which the Wealth of Nations had deprived it; and, by thus establishing two different lines of argument, he embraced the whole subject. In the same way, it was incumbent on Cullen, after having constructed a theory of disease by reasoning from the solids, to have constructed another theory by reasoning from the fluids; so that a coördination of the two theories might have raised a science of pathology, as complete as the then state of knowledge allowed.827 But to this, his mind was unequal. Able though he was, he lacked the grasp of intellect which characterized Adam Smith, and which made that great man perceive, that every deductive argument which is founded on a suppression of premisses, must be compensated by a parallel argument, which takes those premisses into account.828 So little was Cullen aware of this, that, having built up that system of pathology which is known to medical writers as Solidism, he never took the pains to accompany it by another system, which gave the first rank to the fluids. On the contrary, he believed that his plan was complete and exhaustive, and that what is termed Humoral Pathology was a fiction, which had too long usurped the place of truth.829
Several of the views advocated by Cullen were taken from Hoffmann, and several of the facts from Gaubius; but that his pathology, considered as a whole, is essentially original, is evident from a certain unity of design which is inconsistent with extensive plagiarism, and which proves that he had thoroughly thought out his subject for himself. Without, however, stopping to inquire how much he borrowed from others, I will briefly indicate a few of the salient points of his system, in order to enable the reader to understand its general character.
According to Cullen, all the solids in the human body are either simple or vital. The simple solids retain, after death, the properties which they possessed during life. But the vital solids, which form the fundamental part of the nervous system, are marked by properties, which disappear directly death occurs.830 Hence, the simple solids, having fewer functions than the vital, have also fewer diseases; and the maladies to which they are liable admit of easy classification.831 The real difficulty lies in the vital solids, because on their peculiarities the whole nervous system depends, and nearly all disorders are immediately due to changes in them. Cullen, therefore, made the nervous system the basis of his pathology; and, in speculating on its functions, he assigned the chief place to an occult principle, which he termed the Animal Power, or Energy, of the brain.832 This principle acted on the vital solids. When the principle worked well, the body was healthy; when it worked ill, the body was unhealthy. Since, then, the state of the vital solids was the main cause of disorder, and since the Energy of the brain was the main cause of the state of the vital solids, it became important to know what the influences were which acted on the Energy, because in them we should find the beginning of the series. Those influences were divided by Cullen into physical and mental. The physical were, heat, cold, and effluvia, the three most potent of the material disturbers of the human frame.833 The mental influences, which excited the brain to act on the solids, were comprised under six different heads, namely, the will, the emotions, the appetites, the propensities, and, finally, the two great principles of habit and of imitation, on which he, with good reason, laid considerable stress.834 In arguing from these mental causes, and in generalizing the relations between them and the sensations of the body, he, faithful to his favourite method, proceeded deductively from the metaphysical principles then in vogue, without inquiring inductively into their validity, such an induction being, he thought, no part of his duty.835 He was too anxious to get on with his dialectic, to be interrupted by so trifling a matter as the truth or falsehood of the premisses on which the reason rested. What he did in the metaphysical part of his pathology, he also did in its physical part. Although the blood and the nerves are the two leading features of the human economy, he did not search into them by a separate induction; he subjected them neither to chemical experiments in order to learn their composition, nor to microscopic observations in order to learn their structure.836 This is the more observable, because though we must admit that animal chemistry was then generally neglected, and that its real meaning was scarcely understood until the wonderful labours of Berzelius revealed its importance, still the microscope was ready to Cullen's hands; it having been invented a hundred and fifty years before he completed his pathology, and having been in common scientific use for about a hundred years. But his love of synthesis overcame him. His system is constructed by reasoning from general principles; and of that process, he certainly was a consummate master. Between the premisses and the conclusion, he hardly ever lets error creep in. And, in reference to the results of his speculations, he had one immense merit, which will always secure to him a conspicuous place in the history of pathology. By insisting on the importance of the solids, he, one-sided though he was, corrected the equal one-sidedness of his predecessors; for, with extremely few exceptions, all the best pathologists, from Galen downwards, had erred in ascribing too much to the fluids, and had upheld a purely humoral pathology. Cullen turned the minds of men in the other direction; and though, in teaching them that the nervous system is the sole primary seat of disease, he committed a great mistake, it was a mistake of the most salutary kind. By leaning on that side, he restored the balance. Hence, I have no doubt, he indirectly encouraged those minute researches into the nerves, which he would not himself stop to make, but which, in the next generation, gave rise to the capital discoveries of Bell, Shaw, Mayo, and Marshall Hall. At the same time, the old humoral pathology, which had prevailed for many centuries, was practically pernicious, because, assuming that all diseases are in the blood, it produced that constant and indiscriminate venesection, which destroyed innumerable lives, besides the irreparable injury it often inflicted both on body and mind; weakening those whom it was unable to slay. Against this merciless onslaught, which made medicine the curse of mankind, the Solid Pathology was the first effective barrier.837 Practically, therefore, as well as speculatively, we must hail Cullen as a great benefactor of his species; and we must regard his appearance as an epoch in the history of human comfort, as well as in the history of human thought.
It may, perhaps, facilitate the conceptions of unprofessional readers, if I give, in as few words as possible, a specimen of the way in which Cullen employed his method, in investigating the theory of some one class of diseases. For this purpose, I will select his doctrine of fever, which, though now generally abandoned, once exercised more influence than any other part of his pathology. Here, as elsewhere, he reasons from the solids.838 Disregarding the state of the blood, he says, that the cause of all fever is a diminished energy of the brain.839 Such diminution may be produced by various sedatives, the most common of which are effluvia, whether marsh or human, intemperance, fear, and cold.840 Directly the energy of the brain is impaired, the disease begins. Rapidly passing through the nervous system, its first palpable effect is a chill, or cold fit, which is accompanied by a spasm on the extremities of the arteries, particularly where they touch the surface of the body.841 This spasm on the extreme vessels, irritates the heart and arteries, and the irritation continues till the spasm is relaxed.842 At the same time, the increased action of the heart restores the energy of the brain; the system rallies; the extreme vessels are relieved; while, as a consequence of the whole movement, sweat is excreted, and the fever abates.843 Shutting out, therefore, all consideration of the fluids of the body, the successive stages of languor, cold fit, and hot fit, might, in Cullen's opinion, be generalized by reasoning merely from the solids, which, furthermore, produced his well-known distinction between fevers, the continuance of which is owing to an excess of spasm, and those, the continuance of which is owing to an excess of debility.844
A similar process of thought gave birth to his Nosology, or general classification of diseases, which some have regarded as the most valuable part of his labours;845 though, for reasons already mentioned, we must, I think, reject all such attempts as premature, and as likely to work more harm than good, unless they are simply used as a contrivance to aid the memory. At all events, the Nosology of Cullen, though it exhibits clear traces of his powerful and organizing mind, is fast falling into disrepute, and we may be sure, that, for a long time yet, a similar fate will await its successors. Our pathological knowledge is still too young for so great an enterprise.846 We have every reason to expect, that, with the aid of chemistry, and of the microscope, it will continue to grow more rapidly than it has hitherto done. Without venturing to predict the rate of its increase, we may form some idea of it, by considering what has been effected with resources very inferior to those we now possess. In a work of great authority, published in the year 1848, it is stated, that since the appearance of Cullen's Nosology, our mere enumeration of diseases has almost doubled, while our knowledge of the facts relating to disease has more than doubled.847