DR. ADDISON ON HEALTHY AND DISEASED STRUCTURE. * THERE have been
so many instances of error, supported not only by logical reasoning, but by what seemed (till overturned) demonstrative
experiment, that we may safely land in these conclusions. No medical theory can be held to be so positively established, that the inquirer should be blamed for investigations calculated to overthrow it ; neither should a new view or hypothesis be contemptuously rejected because it
is imperfectly explained or does not logically hold together. It may be said that it these propositions are true medical science must be in a very uncertain and unsettled state : and such is probably the ease. At the same time, practice, depending as it does upon individual expe- rience, perception, observation, and even tact, is a very different thing from a general theory. A groom may manage horses very well though he knows nothing of the history or philosophy of equitation. In like • on Healthy and Dimmed Structure, and the True Principles of Treatment for the Cure of Disease, especially of Consumption and Scrofula; founded on Microscopical
Analysis. 13y William Addison, &c. Published by Churchill.
manner, a physician may be a very safe and suocessful practitioner, though he holds opinions on the origin and nature of disease which are philosophically doubtful. If the sceptical reader is still unsatisfied, let him remember, that on any other hypothesis, every alleged discovery on the nature of disease must doom all past ages to the horrors of a wrong treatment, and that future generations may perhaps find out that we are in the same uncomfortable condition. At all events, he may console him- self with the fact, that when various and indeed opposite principles of treatment were tried in some foreign hospital, the proportions of deaths and recoveries were pretty much the same. It is rare cases that call for the rare physician. Nature, in the gross, cures or kills, let the doctor do what he may.
These remarks apply in a cursory manner to the book before us. Dr. Addison professes to have discovered, by means of analogy and the micro- scope, a new and true cause of diseased structure, and a true principle for the cure of disease- The view itself is broad and intelligible ; but it does not closely cohere, and it is not proved. Even if we admit it to be true, we do not see that it causes any extensive modifications in judicious practice, though the principle may place the practice on a firmer ground ; which is no doubt a great thing gained. There are also minor views which Dr. Addison derives from his great theory or hypothesis. To us they seem independent of it, but of more value.
To enter at length into Dr. Addison's theory of healthy and diseased structure, would require some space, and involve scientific technicalities if not obscurities. Its outline may be thus stated. The material de- ments of all organic beings, whether plants or animals, originate from minute cell-organisms. " Recent microscopical researches have esta- blished the fact, that the primary texture of the human embryo and its appendages is corpuscular,—that is to say, composed of corpuscles or cell-organisms having but a slight coherency." These cells are what Dr. Addison terms the general law. As the embryo increases, the ele- ments of its structure advance to what he calls its special laws—fibres, cartilage, and bone. In vegetables there is an analogous progress from (1) cells to (2) coherent cellular textures, and (3) incoherent corpuscu- lar and coherent cellular textures, conjoined with the addition of sto- mata, spiral fibres, and woody textures. Dr. Addison also founds a good deal upon the analogies or alleged analogies between vegetable and animal life ; which sometimes seems to us more ingenious in resemblance than conclusive in proof, or else so obvious as hardly to be of any new argumentative weight. For example, it is not new to tell us that two laws influence vegetables, and of course animals. The one is inherent : what in common parlance is termed the nature, so far as properties are in question; and constitutional, as regards their power of self-develop- ment, or of resisting external influences. The other is external : as the influence of soil, air, climate, upon a plant ; of diet, ventilation, exercise, mental emotions, upon a human being. Neither is it by any means a revelation to tell us that plants and animals can be injured by noxious influences, improved (within certain limits) by beneficial influences, or that when disease has been induced by hurtful conditions, it may be cured by their removal alone, without use of medicine. The real prin- ciple of Dr. Addison, we conceive, may be stated thus. In vegetables, if injury happens to a part, or if the plant is exposed to unfavourable con- ditions, or has a "bad constitution," then, though the nutritive process may go on, (at least for a while,) it either nourishes a morbid growth or causes an unnatural development ; the nutritive function inducing dis- ease, instead of developing growth or maintaining health. The reason of this is, that nutrition, instead of obeying the special laws of development, Ws back or retrogrades to the general or primitive type. Upon this principle of retrogradation the theory of Dr. Addison rests. "Retrograde metamorphosis (in plants) occurs when the form and qualities of a texture are completely changed by the intrusion of elements distinctive of a prior or lower type: as when the green chlorophylle cells of the leaf intrude upon and displace the coloured cells of the petal; or when the structure of the stamens assumes the characteristics of the petals. In these cases, the function, quality, and character of an organ, are subverted, not from the intrusion of elements wholly foreign to the organism, but in consequence of the displacement of natural elements by others of a prior or lower type."
A similar principle, he says, is at work in man. When disease to the extent of lesion takes place, it arises from some check which nature has received ; the nutritive particles of the blood, instead of maintaining the advanced structures (of fibre, cartilage, or bone) retrograding to the formation of the primitive cell-organisms. This condition, in Dr. Ad- dison's theory is what is called the scrofulous constitution. When it is sufficiently advanced to supersede a large part of the higher structures by the primitive inferior structure, the function of the part cannot be performed, and the patient dies. During the time it is rapidly progress- ing to this fatal termination, the patient is ill—in a consumption (for Dr. Addison chiefly confmes himself to the lungs) ; while it is slowly
advancing, he is an invalid, or of delicate health. If either an acute inflammation or a suspected scrofulous condition is treated, and the patient recovers, the recovery may be of three kinds. 1. A perfect cure; where the foreign matter, (tubercles, &c.) is absorbed, and the .organsestored toils original structure. 2. An imperfect cure; where the foreign matter is expelled, and the lesion heals, but with some hurt to -the natural structure,—as a scar after a severe burn, the loss of a part of the lung, and the adhesion of the opposite parts. In this case, .the. function of the organ is not so well discharged : the health is cense- eli2ently inferior to what it was, and the patient may be considered de- licate; but he does not bear about with him a diseased strtictore, whose tendency is to retrograde. 3. What may be called a deceptive cure; where the active disease is checked, but the tubercles are neither absorbed , nor expelled. There is consequently an inhetealt tendency to continue the &position of tubercles, and the patient is something more than dellenie- In fiet, acrofelous. There is, of course, a fourth state,' where the patient, though "better than he was," is still obviously ill, and the disease present though less active. This hypothesis or theory may be correct, but we have found slender proof of it, unless the following curious experiment , upon the circuladoa of the blood and inflammation be received as conclusive, "If the circulation of the blood be observed with the microscope, in vessels or a transparent texture in the living animal, without any previous rude handling or irritation, the stream is seen rapid and uniform, without any check or perturb*. tion•' and it is impossible, from the rapidity of the current, to disonminate itS cells or corpuscular elements, except that here and there colourless cells, by clinging to the sides of the vessels, or slowly gliding along them, become dis- cernible. But if the part under observation be irritated, the regularity if the stream is disturbed in a very remarkable manner, and, as if in consequence the e- of, colourless cells in great multitudes are seen separating themselves from the current—becoming fixed to the walls of the vessels. Some time after the ap. pearance of this phmnomenon, a slender line of colourless matter is m se r les; visible between the stream of red blood and the solid texture, in which the sta. tionary cells are embedded; so that the irritant, of whatsoever nature it be, has produced a separation between the colourless and red elements of the blood, which is seen to take place within the living vessels, the red flowing onward sometimes with the utmost rapidity, the colourless remaining stationary, and forming a new interior coat or wall to the vessels. The nature or meaning of this phenomenon is interpreted by the result, which clearly proves it to be one of increased nutrition; for the irritated texture in a few hours is much thickened, and its elements altered, multiplied, or increased. And the fact clearly shows how the elements of any special texture may become mingled with or supplanted by cell-organisms furnished from the blood.
'We are precluded from making this satisfactory and conclusive observation in the living human body, because there is no accessible part sufficiently thin and transparent for the purpose; but we have ample grounds for admitting that in man analogous irritants are followed by similar results. For if blood be drawn from the reddened skin of a blister, scarlet-fever, or erysipelas, where new layers of cuticle are forming, or from the neighbourhood of a part discharging pus, an unusual amount of colourless cells may be observed in it with the microscope.
"That the separation of the colourless cells and protoplasma of the blood from the red current is an ordinary phtenomenon of growth or nutrition, appears to be proved by a careful microscopical examination of the walls of blood-vessels in embryonic structures."
Neither, in the absence of satisfactory proof, is the theory logically cohe- rent in itself and its consequences. No doubt, in the case of special hurt; we see in the experiment just quoted what may be received as the cause of inflammation ; but this does not account for (what seems to be) spon- taneous disease. In like manner, there appears no reason why the actual loss of a part should be a better safeguard against relapse than the pre- sence of tubercles ; which frequently exist, as Dr. Addison admits, without shortening life or apparently iojuring health. The cause, not of the.mis- chief (visible by the eye or the microscope) to a part, but the cause which caused the mischief, is the thing to be sought for ; and which in some cases we call constitution, and in others, if we try at all, we can only resolve into destiny. At the same time, every truth is an advance; and should Dr. Addison's theory be established, it will be a great addition to medical knowledge.
As a literary production, this work is not of the highest class. It is overlaid with cognate or subordinate topics, which, if they have a relation to the theory, are not essential to its exposition. The exposition is con- sequently clogged, and the reader needlessly burdened. The book, how- ever, contains some valuable remarks on disease, and especially consump- tion. The views on the treatment of lung affections are also worth atten- tion: not that they contain anything absolutely new, but they are more systematic. This arises, no doubt, from the systematic theory of the author • which is, that an appropriate medicine destroys the formation of the cell-organisms, but promotes the restoration of the special develop- ments. The most valuable things are some incidental passages on inflam- mation; the curative processes of Nature in healing wounds or repairing lesions ; and the manner in which (from a hint in Mill's Logic) Dr. Addison urges the "many antecedents" that may go to produce a dis- ease, and the necessity of looking back into the history of a patient and his disorders, instead of merely considering his present case.
Previous page
