DR. DICKSON'S 'UNITY OF DISEASE.

Da. DICKSON is the author of the Fallacy of Physic, which we characterized on its first appearance* as rather the " Fallacy of Other People's Physic." The present volume follows out the view the Doctor there maintained, that there is but one disease ; which disease is Fever.

The theory of Dr. DICKSON may be briefly stated thus. Putting aside injuries from violence, the condition of "out of health" is induced, not by internal, but external causes; as the passions, too much or too little food, intemperance, cold, and a continuance of various depressing circumstances ; all of which operate by means of nervous perception, (we conceive he means sensation.) At first, this influence, be it which it may, merely excites a constitu- tional disturbance : and we may intimate, that if it be slight, and the individual strong, Nature will cure herself by her own efforts. If otherwise, the disorder proceeds ; and, as we have all a weak point, bodily as well as mental, it settles itself there ; and becoming acute disease, perhaps kills the patient at once, or chronic, and embitters his life, which in the long run it terminates, assisted in both cases by the physician. On a post mortem ex-

Spectator, No. 440. 31 December 1836.

arnination, the brain, the lungs, the liver, or any other organ, may be found injured ; and then these doctors say, " Ab, he died of a liver complaint," or, otherwise as the case may be: whereas, this functional injury was merely a symptom of some primal disease, the last of a series of causes,—the " Great First Cause" of which, it should be the business of the philosophical physician to discover. For did we know it, this structural change would be prevented ; or if it had supervened by neglect or ignorance, we should in most cases he able, by acting upon the primal disease, to restore health, and enable Nature to absorb the morbid part and supply a healthy one.

Now, according to Dr. Thomas he has discovered this primal disease; which is Intermittent Fever. Not that he cares about a name, but lie calls it fever because he resolves all disease into temperature,—(meaning—for he is not rigid in his terms—that

our sensation of temperature is the symptom of the universal did- ease); and intermittent, because no disease is, as the theories of other physicians would imply, a fixed entity, but has its remissions and exarcebations; or in other words, the patient is sometimes better and sometimes worse. The type of this universal disease is the common ague ; and he holds that medicines which act bene- ficially in ague, act beneficially in all disorders. The medicines Dr.

DICKSON uses in practice, are not very numerous ; but they are very powerful in their natures -s ; where structural lesion exists, or is sus-

pected, he generally combines a medicine of universal with one of

local operation. The usual descriptive terms he repudiates : how can quinine, he asks, be called a tonic, when it disagrees with a patient,

and makes him worse ? In chronic disorders, a medicine requires

to be varied ; as it will rarely be beneficial for long together. Blood-letting Dr. DICKSON has discarded under any circumstances, even in apoplexy ; substituting cold effusion and purgatives. The cause of this change in routine practice, was his constantly,during his military experience, seeing soldiers brought to the hospital, and bled profusely, sometimes to death, sometimes to recovery ; but the fact was forced upon him, that they were never the same men afterwards. His main argument against it may be put thus. If blood has escaped from a ruptured vessel, no bleeding will remove it ; if that extravasated blood is to kill the patient, die he must : but if there is a chance that the absorbents could gradually take it up, and throw it out of the system, then by bleeding you weaken the patient, and, of course, the action of the curative function.

That the first cause of disease, like the principle of all other things with which we are acquainted, is very simple, we believe. We also believe that blood-letting is a iemedy requiring the greatest caution and the nicest judgment ; and that its abuse, in the hands of active practitioners, is constantly ruining the health, or taking the life of thousands. We will also admit that the con- ceit and ignorance of second-rate men has in all ages involved the science of physic in mystery, and overlaid it with jargon ; and that its progress has in reality been little since the times of Hie- POCH ATES and CELSUS. But we are not to overturn one heresy to set up another ; and we must say that Dr. DICKSON has not proved his case. Simple as are the first causes of things, the in- stant they are combined with others, so many secondary causes come into operation, that the primum mobile cannot properly be alone regarded. And allowing that our author had proved, which he has not, that all disease originates in an influence acting on the " nervous perception," yet it does not follow, that when it became complicated with the numerous tissues, structures, and functions of the body, its original character would remain un- affected.

Nor can the Doctor's practice be said to conform to his theory ; for, except in the repudiation of blood-letting, and in a greater simplicity of remedies, he does not seem to greatly deviate from the received mode. Putting causes aside, there are six great bodily changes we can effect. We can increase the excretions of the skin, kidnies, and stomach and bowels; we can soothe by opiates, stimulate by tonics, and act upon the system by alteratives either medical or moral, (as change of scene,) all of which Dr. DICKSON seems to adopt. The specific mode and propriety of their appli- cation, is a question for him and other doctors to settle " upon the case."

Passing from the views of the author to his book, it may be said to be the product of a good deal of experience and indepen- dent thought, and to possess much directness and vigour of ex- pression. It is dashed, however, by drawbacks. The Doctor as- sumes points which Ile ought to have proved : about the nature of some of his cures we say nothing, because we must take them on his veracity, but it has a suspicious appearance to give the names of the medicines without the doses : his contemptuous mention of anatomy and pathology, has an empirical air, at the least; and the coarse manner in which lie alludes to other practi- tioners, is not always justified by the opposition he may have met with, because it is not limited to his opponents. In short, the Unity of Disease is more useful for what it may suggest, than

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or what t will teach—rather a hint to be pursued than a theory to be admitted ; and, like most other books of its kind, is more successful in its attacks upon what is established, than for esta- blishing any thing of its own. As a specimen of Dr. DICKSON'S manner, we may take his re- marks on the use of the much-famed stethoscope ; a rage, like many rages, not altogether founded in reason.

But how shall we speak of diseases of the heart, of palpitation and tem. 1. Quinine, calomel, prussic acid, arsenic, opium, iron, silver, Ste. porary cessation, or remission of its action, disorders constantly misunderstood, and as constantly uualetreated. Complain but of flutter and uneasiness in any part of the chest, the stethoscope, the oracular stethoscope, is immediately produced! Astonished — in many instances terrified — the patient's heart beats rapidly ; he draws his breath convulsively, and the indications obtained by means of this instrument, at such a moment of doubt, anxiety, and fear, are registered and recognized as infallible ! The most extraordinary prognostics are consequently given ; extraordinary, if they did not by the subsequent treat- ment, like prophecies, tend to verify themselves. Let the practitioner with- draw his eye for a time from a mere sympton ; let him observe how other muscles of the individual palpitate at times as well as the heart, and act like that convulsively. Finding these symptoms to be remittent in every case, and complicated with others all equally remittent, would he still persist in his small bleedings, his repeated leeches, his purges? measures of themselves sufficient for the production of any and every degree of organic lesion be already fan- cies he has detected ! Would he not rather reflect with horror on his past treatment ? and endeavour, by another and a better practice, to enable his patient to escape the sudden death to which he bad in his mind's eye devoted him? How many a physician by such a prognostic has obtained unmerited credit for foresight and sagacity, while he only taught the patient's friends to be prepared for an event he himself was materially contributing to hasten !