The Dublin Journal of Medical Science

were women and children, the most interesting and helpless class of the community, in the investigation of whose diseases, more espe cially the latter, a degree of acuteness and judgment, far beyond that necessary in treating the diseases of males, was so essential, should be handed over to the blundering or half informed empiric? No; such a state of things could not be expected to continue, they have of course yielded to the all powerful march of intellect, and now the obstetric department holds the rank it merits.

Nay, not only have the offensive and injurious restrictions alluded to been removed, but an emulation absolutely exists upon the part of the different colleges, to attach the midwifery practitioner to themselves.

Professorships of widwifery have been instituted, and inducements held out to obstetric recruits on all sides, and midwifery has at length been wisely insisted upon as an essential ingredient in the education of both surgeon and physician. In fact, at the present moment, the accoucheur is as much in repute, as formerly he was the reverse. Thus the duty which at one time devolved exclusively upon the Master of the Lying-in Hospital, has been divided by other midwifery teachers. The result of this, I doubt not, after the fever and excitement attending these changes shall have subsided, will be, that midwifery will be permanently fixed in that rank of importance as a profession, which it should long since have held, and to which it is so eminently entitled. In the mean time, the effect upon science will prove serviceable by the mass of talent which competition brings to bear on its investigation. Indeed this fact has been already proved by the many literary productions that have issued from the press within the last few years; witness a work on the "Signs and Symptoms of Pregnancy," containing much information, by Dr. Montgomery, Professor of Midwifery to the College of Physicians; as also a "Systematic Treatise on the Diseases of Children," being a joint production by Professors Evanson and Maunsell, a work much wanted; and a "General Treatise on Dis. eases of Females," by Dr. Churchill, Lecturer on Midwifery to the Richmond Medico-Chirurgical School; to which may be added, the valuable Reports of the several Lying-in Institutions, as well as many detached and interesting papers on a variety of subjects connected with our art, by Drs. O'B. Adams, Beatty, Cusack, Ireland, and H. Carmichael, &c.

Let us now confidently look to this Society as a means of still further increasing our knowledge by identifying obstetric practitioners and students in midwifery in one common and united effort. If union be strength, then what more than ignorance requires its aid to overcome?

Let it not be supposed that the object of this Society is alone to instruct the student, when it is more especially calculated to unite the practitioners as a body, and to improve the art; neither let it be imagined that it is restricted in its efforts to the exertions of midwifery practitioners solely, our extensive field of practice has been much

enlightened by the labours of such men as Cheyne, Marsh, Graves, and others, individuals occupying high stations in the walks of medical and surgical science, and I am happy to inform you that many such have already not only identified themselves with its objects, but even (as we should expect from their well known zeal in every thing tending to improve and extend the knowledge of our art) have undertaken to assist our infant efforts by furnishing us with papers for our meeting; need I, in making this announcement, enumerate the names of Doctors Graves, Stokes, Lendrick, Harrison, Hart, Smith, Brady, Wilde, and Mollan. In returning my best thanks to my junior friends for the attentive hearing they have afforded to me, and to my senior fellow-labourers for evincing, by their attendance here, that spirit of generous scholarship which delights to encourage in others the studies itself loves, allow me to conclude in the words of St. Bernard, "And now, my, dear friends, you have laid this task upon me, and not only you, but as you have given me to understand, from Ireland, all the society with you. I, therefore, willingly obeyed, and the rather as you did not require an eloquent discourse, but a plain narrative. I have, however, used my endeavours that the account I clear, instructive, and devout, and, I trust, not tedious to the overgave should be smooth, curious."

Death of Professor Broussais.-In noticing this event, which occurred in November, 1838, we would desire to give an analysis of the character and labours of Broussais, one of the most remarkable physicians of modern times; but this our limits will not permit.

In this country a very limited notion is generally entertained of the doctrine of Broussais, and the term has been almost exclusively confined to that part of it which related to fever; a doctrine, which though erroneous as applied to typhus generally, had strong evidences in its favour, when considered with reference to the disease in Paris. But, in truth, this part of the doctrine which excited such opposition, was but a necessary consequence of, and part of the almost exclusive solidism which characterizes the medical doctrine of Broussais. He sought for a formula for disease. health consisted in the balance of function; disease in the disturbHe conceived that ance; and death in the cessation: but as function depended on organs, so organic change of some kind accompanied the lesion of function; hence, there was no essential disease, no general affection, not springing from a local organic cause, and consequently fever was not essential, but symptomatic. Here was the great error of Broussais; not that he declared that fever was nothing but gastro-enteritis, but that he took as a basis of his pathology a doctrine which was far from being proved.

His next error was in the adoption of the doctrine that he could reduce all diseases to the formula of a plus or minus vitality of organs. The phenomena of altered secretion, increased nutrition, inflammation, and ulceration, being considered as examples of plus vitality, it followed, first, that an antiphlogistic treatment, general and local, VOL. XV. No. 43.

2 A

should be adopted in almost every case; and next, that the same principles of treatment were applicable to a vast number of diseases.

As a further consequence of this doctrine, Broussais held that irritation did not change its nature, and therefore he pursued the antiphlogistic treatment too long, unaware that in many local diseases a period arrives when antiphlogosis, which at first answered well, ceases to control the disease, and that to complete the cure, we must change to a tonic and stimulating remedy. Finally, if diseases only differed in the degree of irritation, there was no need for specifics, the action of which he at first denied.

The doctrinal errors of Broussais may be thus stated. His exclusive solidism; his doctrine that all diseases could be reduced to the formula of plus or minus local vitality; his opinion that irri-tation did not change its nature; and his denial of specificism.

In the doctrine of plus or minus vitality, Broussais has been accused of merely following Brown. In an early notice of the work of Sabatier on Revulsion, we have observed that Brown used the terms sthenia and asthenia, as general terms applying to the state of the whole body or system. Disease was with him the result of a general condition. Broussais on the other hand expressly denies this doctrine of Brown's, and holds that all diseases are primitively local, there being no such thing as a general exaltation, or general diminution of the vitality of organs.

With respect to the theory of typhous fever, it seems certain, that the error was first in announcing as a general proposition, what was true but in a certain locality; and next, in a misapprehension of the nature of the lesion of the intestines. It is almost certain, that the follicular disease is the effect of the fever; a local affection, secondary, though peculiar to the general disturbance. Yet in his announcement of the constancy of the lesion in Paris, Broussais has been borne out by almost every subsequent observer. But disease must be studied in various countries before we can establish any great law in pathology; and every dispassionate man must admit the essentiality of typhus in Great Britain and Ireland.

Books