274 Dr Alison's Outlines of Physiology.

Art. VII.- Outlines of Human Physiology. -By William Pul- teney Alison, M. D., F. R. S. E., Fellow and late President of the Royal College of Physicians, Edinburgh; Honorary Fellow of the King and Queen's College of Physicians in

Ireland; Professor of the Institutes of Medicine in the Uni-

versity of Edinburgh ; and one of the Physicians in Ordinary to Her Majesty in Scotland. At the first foundation of the chair of the Institutions of Me-

dicine, or what was occasionally termed the Theory of Physic, in the University of Edinburgh, in 1741, Dr Whytt the first

Professor, made his course consist of physiology and general pathology, and therapeutics, or a view not only of the functions of the human body in a state of health, but of the deviations which they were liable to undergo in disease, and of the princi- pal circumstances under which these deviations took place; and a general view of the external effects produced, and of the means to be employed for obviating or removing them.

This plan of communicating the knowledge of the principles of medicine was imitated from the foreign teachers, more espe- cially from Boerhaave, who was conceived not without justice, to be the great authority in the method of teaching the science of the art of healing. Boerhaave had already published for the use of his auditors, a system of the Institutiones of Medicine, in which he arranged, after the example of his predecessors, the whole subject under five general heads; Physiology, or the knowledge and explanation of the animal economy, and the laws by which its actions are regulated ; Pathology, or the general doctrines of diseases, their differences, their causes, and their ef- fects : Semiotics, or the doctrine of symptoms, or the general consideration of the symptoms of health and disease : Hygiene, or the doctrine of the preservation of health, containing prophylaxis and the diet necessary, to insure longevity; and Therapeutics, or the method of curing diseases, the consideration of the indica- tions pointed out or suggested in different morbid states, and a general view of the remedies or curative means and agents, by which different indications were to be fulfilled, *

This treatise was so excellent and complete in all its parts, that Haller spent several years of his active life in expounding,

* Institutiones Medicae in' usus Annus Exercitationis Domesticos Digestae Ab Hermanno Boerhaave. Lugduni Batavor, 1713, 1723. Nova Post Tertiam Lug. Bato. Editio caeteris auctior et emendatior, Venetiis 1757- The latter was published near twenty years after his death, which took place on the 23d September 1738, when he was nearly in his seventieth year.

Dr Alison's Outlines of Physiology. 275

illustrating, and enforcing the principles contained in it. The

example of Dr Whytt was followed by Dr Cullen, his successor, in the same chair; and we possess in his valuable, though short outlines of the first part of the Institutions of Medicine, viz. the Physiology, recently republished with his works by Dr Thom- son, sufficient information regarding the method in which Dr Cullen communicated to his pupils the knowledge of what may be termed the first principles of medicine.

After stating that the teaching of physic had been for a long time past divided into the Institutions and the Practice of mer dicine, or the application of the art to particular diseases and persons, Dr Cullen adds, that, according to the general opinion of physicians, before considering the practical applications to par- ticular diseases, it was necessary to premise certain general doc- trines, which are called the Institutions of Medicine.

These, he distinguished into three parts; the first treating of life and health, Physiology ; the second delivering the gene- ral doctrines of diseases, Pathology ; and the third delivering the general doctrines concerning the means of preventing and curing diseases, Therapeutics. The department of the division of Boerhaave and his predecessors called Hygiene, he omitted as a separate division, not because it is not an object of the physician's art, but because, as it consists in knowing and avoid- ing the remote causes of the disease, whether predisponent or occasional, part necessarily falls under the division of Patho- logy called Etiology, and part falls under the general doc- trines of Therapeutics. The department also styled Semiotics which formed one of the five divisions of the older writers and

teachers, he also rejected as a separate head, because properly speaking, it arranged itself under that division of pathology, where the symptoms of diseases are explained, and coincided, consequently, with the general symptomatology of various au- thors.

Of this plan of instruction in the Institutions of Medicine, Dr Cullen completed only the first part, viz. the physiology; for though he introduces many illustrations and proofs derived from the phenomena and effects of disease, yet, as these are all intended to illustrate and enforce his doctrines on the state and

properties of the body in its healthy condition, it is impossible to regard his short treatise in any other sense than as a neat and luminous exposition of the functions of the living body as in health. What his doctrines in Pathology and Therapeutics actually were in his lectures, and what they would have been had they been published, may be easily understood by those who study carefully his First Lines, and the Lectures on the Ma- teria Medica, both of which works contain, doubtless, the most

276 Dr Alison's Outlines of Physiology.

complete system of philosophical Pathology and Therapeutics, which the profession had yet witnessed. To those who are de- sirous to understand and appreciate the judgment, genius, and general ability of this great physician, we would recommend an attentive perusal of his whole writings, as published in 1827, by Dr Thomson, and especially the separate "perusal of the Insti- tutions of Physiology and the Materia Medica.

The method of Dr Cullen was adopted and improved, and completed by his successor in the chair of Institutions, the late Dr James Gregory. Distinguishing the subject into the three divisions, established by Cullen, Dr Gregory combined the

Physiology with the Pathology, so as to form the first part of his course, and made the Therapeutics the second or conclud- ing part a division by itself. The former was first published in 1780, and the whole work appeared in 1782 under the title of Conspectus Medicinae Theoreticae, a work which is well known to have passed deservedly through many editions, whether we consider the elegance of the language in which it is composed, or the clear, terse, and succinct manner in which the doctrines of physiology and pathology, as taught at the time, are expound- ed. The method of instruction thus devised by Dr Whytt and Dr Cullen, and afterwards completed by Dr Gregory, was imi- tated by Dr Duncan, Senior, who, however, only published out- lines of his course of lectures. When Dr Alison succeeded to the chair of the Institutions

of Medicine, he adopted to a certain extent the general princi- ples of the method, but modified them much as the progressive changes in teaching, and the advancement of medical know- ledge demanded. From a variety of causes the doctrines of General Therapeutics have been gradually, but steadily tending to fall under the cognizance of the Professor of Materia Me- dica ; and at present it constitutes an integrant part of his course. When, therefore, Dr Alison undertook the publication of a work to assist the pupils of the University of Edinburgh, in the study of the Institutions of Medicine, he confined the attention of his reader to the two subjects of Physiology and Pathology, leaving the subject of Therapeutics to be studied by itself. Another innovation rendered almost if not altogether indispen- sable, by the advancing progress of medical science, and per- haps also by a due regard to perspicuity in the method of teach- ing, Dr Alison was led by experience to adopt as most effectual in communicating clear and distinct ideas of the two divisions of medical knowledge, which he was engaged in teaching. Dr

Gregory we have seen united the facts, reasonings, and deduc- tions of Physiology with those of Pathology. This connection Dr Duncan separated, and Dr Alison in like manner found,

Dr Alison's Outlines of Physiology. 277

that the only mode of communicating clear ideas on the nature of the actions, properties, and functions of the living body in the state of health, was first to explain them in successive and uninterrupted order, and then to give in a separate and subse- quent part of the course a short view of the characters, pheno- mena, and effects of diseased action, the causes by which they are produced, the circumstances wherein they differ, and the external symptoms by which their presence is indicated.

In our thirty-sixth volume, we gave a short account of the first part of Dr Alison's Treatise, devoted to the Outlines of Physiology, as it appeared in 1831; and we have always had it in view to give a fuller notice of the whole work when it appear ed in its completed form, embracing Outlines of Physiology, and Outlines of Pathology. This took place in 1836.* The work

might then be regarded as presenting a full though compendious view of the Institutions of Medicine, as taught in the University of Edinburgh ; or, in other words, those elementary principles of medical science, the knowledge of which is requisite to enable the physician to recognize the presence, degree, and extent of disease, to know its tendencies, and adopt such practical measures as are requisite to counteract its effects, if tending to disorganiza- tion. We regret that many circumstances have concurred in preventing us from carrying into effect the intention now men- tioned. It is not, however, too late to say that the Outlines of Physiology and Pathology of Dr Alison, is a work not only highly valuable to the pupils of the Edinburgh school, as presenting in a concentrated and commodious form, a methodical digest of the most essential and important facts and inferences constituting the Theory or Institutions of Medicine; but it is also a treatise which all medical readers of every denomination will peruse with ad-

vantage, and from which even the most experienced practition- ers will derive much useful instruction. It is our opinion, in- deed, that the Pathological part of the volume is perhaps the most useful of the two, as it contains the most philosophical and most compendious views we know in the English language, of that species of information which is most directly useful to the practitioner of the healing art. It enables the student to per- ceive the object of all his previous studies, and shows him how he is to apply the information presented by the elementary sciences of anatomy, physiology, and morbid anatomy to the great purpose of his life,?the recognition of the presence, and the means of conducting successfully the treatment of disease.

* Outlines of Physiology and Pathology ; with Supplement. By William Pulteney Alison, M.D., F.R.S.E., Fellow of the Royal College of Physicians, and Professor of the Institutes of Medicine in the University of Edinburgh.

^78 Dr Alison's Outlines of Physiology. Another change, however, in this department of medical edu-

cation requires to be noticed. Partly since the original projec- tion of the work of Dr Alison, and partly since the appearance of that work in its completed form, a considerable change in the didactic duties of the chair has taken place. The institution of the chair of General Pathology in 1831, and since that period, its admission into the Curriculum as requisite to the education of candidates for the degree of Doctor of Medicine, committing to one separate teacher the duty of teaching the general doctrines of Pathology, has furnished the students of the University of Edin- burgh, with the means of devoting to the study of General Pa- thology a more complete and less divided measure of attention, than it was possible to do, when the science was taught as part of the course of Institutions of Medicine. This arrangement also enabled the Professor of the Institutes, to devote a larger proportion of his course to the subject of Physiology alone. As to that of Pathology, he generally devoted at least fifty lec- tures, the time occupied in which would now be applied to the duty of explaining the history of the functions of the living body in a state of health only.

It is not to be denied that this method presents various ad- vantages which are either imperfectly obtained, or altogether withheld by the other method of combining the two sciences. Physiology, that is the study of the whole of the functions of the living body in a state of health, is a science of such vast ex-

tent, deriving its materials from so many different sources,? embracing so many isolated, and sometimes contradictory classes of facts, and presenting so many complicated and difficult in-

quiries, that to present a just and useful view of it, may well re- quire a full course of lectures of six months' duration, or even a longer space, did the period assigned for professional education allow. In this point of view, therefore, the mere physiological department of the course reaps the advantage of a decided be- nefit. It is rendered more full and perfect; the lecturer has an opportunity of explaining the difficult and obscure portions of the subject with more care and attention, and in greater de- tail ; and the student enjoys the advantage of forming clearer and more correct notions on many points, 011 which want of time might oblige the teacher and the author to rest satisfied with hasty, vague, and superficial statements and inferences, which, considering the great proneness to misconception on the part of many pupils, might lead to mistaken notions. on many of the laws which regulate the functions of the animal economy. Such

inconveniences, if actually resulting from the former arrange- ment, are likely to be obviated altogether in the present.

In publishing a new edition of the Outlines of his Lectures,

Dr Alison's Outlines of Physiology. 279

Dr Alison has kept this arrangement in view. He confines his

present work exclusively to the subject of Physiology; and though every one who takes interest in the progress and im-

provement of pathological knowledge, must regret the want of a compendious view of the latter science, from a physician who has devoted so much attention to it, and who is in every sense so well qualified to explain the principles and laws of morbid action; yet all who are anxious to form clear and precise notions on the ascertained facts in physiology, will be happy to see the present work, exhibiting as it does in a short compass, a correct and

comprehensive view of the present state of physiological know- ledge.

It comes not within the object of this notice or the usual plan of this Journal, to examine in detail works of the nature of that before us. It is merely requisite to specify its prominent and distinguishing characters.

In a science embracing so many different divisions, resting on so many facts and classes of facts, and from the nature of the objects with which it is conversant,?facts so difficult to be as- certained and liable to so many sources of fallacy, and, above all, where even the inferences deduced are sometimes liable to be perverted or overstrained, the first and principal object is to draw a clear and visible line of distinction between the facts as- certained and the facts not ascertained, and to arrange them in methodical order, and the second is to present the deductions and inferences to which they legitimately lead. This is the method which Dr Alison has adopted, and to which he has ad- hered, as faras is practicable, throughout the volume.. The phy- siological reader will find the facts stated with great accuracy and precision, and only those facts which are entitled to that valuable character; and then he is taught the various inferences and deductions to which they lead, and the degree of evidence by which these deductions are supported.

As there is no department of medical knowledge in which lo- gical precision is more required than this, none in which it has been less carefully and strictly employed, and none in which it is more important for the student to be taught to think and rea- son for himself, the present volume may be confidently recom- mended as the best suited for this purpose at present extant in the English language. The first or preliminary chapter presents a just and philoso-

phical view of the objects of physiological inquiry, the mode of conducting the study of the science, and the nature of the evidence required for the conclusive establishment of its prin- ciples.

In the second chapter the author gives a very philosophical

280 Transactions of the Provincial Association.

exposition of the most general laws of vital action, and explains and enforces the peculiarities of vital action as distinct from those of mechanical and chemical action, in a manner which will be approved by all those who have studied most carefully the na- ture of the actions of living bodies.

In the other portions of the work, the physiological reader.will find in the fourteenth chapter on the Mental Faculties, in the fifteenth, on Voluntary and Instinctive Motion, in the sixteenth, on the Involuntary Action of the Mind on the Body, and in the seventeenth on Sleep, most correct and instructive views on these obscure and difficult subjects. These we specify, not because throughout the whole treatise the different divisions of physiology are not expound-^? with great ability and fidelity, but because, as these are subjects of peculiar difficulty, and have given rise to various discussions, and much erroneous and fan- ciful speculation, and have very rarely been treated by Physio- logists with the clearness, and correctness, and sound philoso- phical views which are most urgently demanded, it is so much the more agreeable to find them explained and discussed in such a manner that the Treatise may be confidently recommend- ed as a safe and able guide to the young physiological inquirer.