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These observations bring me to the answer of the question stated under this head; and this is, that if there are proper grounds for the distinction between Universal and Local diseases, neither observation nor experience have succeeded in discovering these grounds. One disease, a few diseases may be less general than others; but none can be said to be strictly local and unconnected with the system at large.

As to the other division of the question, whether the circumstance of being attended or unattended by Diathesis, constitutes this distinction, when Diathesis is interpreted as used by Brown, the distinction vanishes into nothing, and becomes altogether unserviceable. On one aspect of this subject, namely, the necessity of a sufficient and good medical education, combining the full study of medicine with that of surgery, in order to make an accomplished and serviceable medical practitioner, several judicious observations were made by Dr Thomson so long ago as in 1813.* Those, however, who wish to understand well the nature of the alleged distinction between Universal and Local diseases, will do well to study with attention the writings of the late Mr Paynter Vincent, those of Sir Benjamin Brodie,‡

* Lectures on Inflammation. Edinburgh, 1813. Introduction.

Observations on Some of the Parts of Surgical Practice. By John Paynter Vincent, late senior surgeon to Saint Bartholomew's Hospital. London, 1847. 8vo, pp. 364.

Lectures illustrative of Various Subjects in Pathology and Surgery. By Sir Benjamin C. Brodie, Bart., F.R.S., Serjeant Surgeon to the Queen, &c. London, 1846. 8vo, pp. 411.

Pathological and Surgical Observations on the Diseases of

those of Mr Macilwain, and the Lectures on Sur gical Pathology by Mr Paget.†

9. Dr Brown's idea, that diseases differ from one another only in Diathesis and degrees of Diathesis, was combated by those who insisted on the importance of the Forms of Diseases, and of the Pathological Conditions, as objects of scientific inquiry, as well as by those who maintained, with Bufalini, the doctrine of Particularism.

Bondioli undertook to shew, that it is necessary for the physician to pay attention, not merely to the Diathesis prevailing in any universal disease, but also to the particular form which it exhibits. By this term, he seems to imply, that the practitioner must attend not only to the constitutional symptoms, as marking more or less vigour of the general economy, and, in particular, of the vascular system, the Joints. By Sir Benjamin C. Brodie, Bart., V.P.R.S., &c. Fifth Edition, with Alterations and Additions. London, 1850. 8vo, pp. 399.

* Medicine and Surgery One Inductive Science; being an attempt to improve its study and practice on a plan in closer alliance with inductive philosophy, &c. By George Macilwain, Fellow of the R. M.-Chir. Society, &c. London, 1838. 8vo, pp. 551.

Remarks on the Unity of the Body, with a view of Improving the Constitutional Treatment of Local Diseases. By George Macilwain. London, 1836.

Lectures on Surgical Pathology, delivered at the Royal College of Surgeons of England. By James Paget, F.R.S., lately Professor of Anatomy and Surgery to the College; Assistant Surgeon and Lecturer on Physiology at St Bartholomew's Hospital. Volume I. Pp. 499. Volume II. London, 1853. 8vo, pp. 637.

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but also to the more local symptoms arising immediately from the organ principally affected. "What Professor Bondioli calls morbid forms," says Tommasini, "(connected with particular influences of different agents on certain parts of the body, and with certain modes of affection that result from thence), and which he very properly distinguishes from diathesis, are, if I mistake not, to be accounted nosological affections."

Bondioli conceived the system of Brown to err fundamentally in directing attention wholly to the diathesis prevailing in a particular disease, and withdrawing it from the form which the disease assumes. In this remark, Bondioli seems to allude to Brown's declaration, that it is enough to guide medical practice to know whether the disease is sthenic or asthenic, and in what degree one or other of these states or diatheses prevails; whereas the practitioner ought, in Bondioli's opinion, to form a more precise judgment as to the seat and intimate nature of the disease, since two sthenic or two asthenic diseases, equal in amount of diathesis, may require different modes of treatment, according to diversities in these other respects.

Bondioli justly observes, that physicians had, from the earliest periods of medicine, made these forms the particular objects of their attention; but that the physicians of our days had introduced the doctrines of Diatheses, and had substituted these in

* "I give the name of Nosological," says the same author, "to those symptoms only which indicate what is the part affected, and the extent of the disease."

place of the proper consideration of the peculiar forms of disease.

Fanzago concurred with Bondioli in thinking that diathesis is not the sole object of consideration in diseases; and in recognising the importance of attention to their forms, which term, he remarks, is not to be limited to the nosological character, but must include the whole history of the disease; so that the attaining a knowledge of the form involves the necessity of both descriptive and historical analysis. But the principal object of Fanzago's Treatise on the Essential Differences of Universal Diseases, was to shew that, independently of the diathesis of Brown, Rasori, &c., and of the morbid form of Bondioli, the medical practitioner must take into consideration the pathological condition, or that particular temporary morbid process, which, in universal diseases, is commonly formed either in some organ, or in some system of the animal economy, but which is to be distinguished from permanent organic alteration, or serious disorganizing lesion of any part. It is, he holds, on the diathesis and pathological condition, or local affection, conjointly, that the form, or nosological character, of universal diseases must depend, and on the latter even more than on the former.

It seems obvious that Fanzago understood the term Pathological Condition as equivalent to the Proximate Cause of Cullen.

10. Another question that has excited a good deal of discussion among Italian pathologists, relates to

the grounds of distinction between Dynamic or Functional and Organic diseases.

The fundamental principle of the system of Pathology which Bufalini has so zealously laboured to substitute for the Brunonian, seems to consist chiefly in this, that it is the organization, and not any abstract property that is the seat of those phenomena in which health and disease consist; that life results from the action of the appropriate stimuli upon the organization; and that it is doubtful whether the organic mixture requires the addition of any particular matter to complete or perfect the organization.*

Hence, in the Essay on Life which he published in 1813, and in which he commenced his attacks upon the dynamical doctrines of Health and Disease, he denied altogether the existence of dynamical or functional diseases, maintaining that all diseases are, in their first origin, organic;—some, indeed, in which the morbid alteration of the organized structure is occult or invisible, and others in which it is evident to our senses; but that there is no dynamical or functional derangement which does not depend upon a change in the organic mixture; and that, consequently, there is no absolute or essential difference between Functional and Organic diseases, both depending upon change in the organic mixture.

These opinions Bufalini restated and illustrated in the first edition of his Analytical Pathology, published in 1819; in his Modena Prize Essay (1823); in his work entitled Cicalate intorno alla Medicina

* Raccolta Di Opere Mediche Moderne Italiane, 1 Tomo. Bologna, 1827.

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