S U R G E R Y. 711 
surgeon will continue to go hand in hand in their career 
of improvement. The former brings from the colleges those 
powers of analysis and of strict logical demonstration which 
the study of the learned languages and the mathematics is 
calculated to develope. While the latter, ever tied down to 
contemplate the gross and visual objects under his knife, re¬ 
duces the discursive flights of theory to accurate and prac¬ 
tical experiment. It is true, that if the physician had gene¬ 
rally made dissection a part of his education, we should 
have seen fewer of those brain-spun systems which anatomy 
has so often overthrown; but at the same time, if surgeons 
had been more generally classically educated, the disgrace of 
being proverbial for a barbarous and inelegant style of 
writing had been spared us, and we might have escaped the 
ridicule which some recent theories of life have tended to cast 
on our logical accuracy. 
We shall not, however, enter further into any question as 
to the respective merits of surgeons or physicians, or rather 
of their courses of education; our own feelings being, per¬ 
haps, too much interested to allow us to be impartial. We 
shall content ourselves with observing that the public, who 
are the best judges of their own interest, have pretty generally 
decided that it is individuals, and not classes, who are to de¬ 
rive honour and profit from the profession, and they appear 
very justly and naturally to think that the division of their 
medical attendants into two or three rival classes, by keeping 
up a spirit of emulation, is conducive to the general welfare 
of the community, and the advancement of pathological 
knowledge. 
The diseases, then, which are assigned to the surgeon, are, 
1st. Every disease which may or can require a manual opera¬ 
tion: as, fracture, dislocation, distortion, tumour, hernia. 
2d. The medical diseases of such parts as are usually the 
subjects of chirurgical operations: e. g. diseases of the urethra 
and other urinary organs; syphylis, diseases of the eye and 
the ear. 
Since, in the treatment of all these maladies, the general 
principles of inflammation and of other morbid actions are 
requisite to be known, and as the practice founded on these 
principles is incalculably more useful than any manual dex¬ 
terity which may be called into play in an operation, it be¬ 
comes necessary to enter somewhat fully into those diseases 
which are 
UNIVERSAL OR GENERAL. 
Notwithstanding the multitudinous divisions of the noso- 
logists, all diseases may be resolved into two classes:— 
diseases of vessels and diseases of nerves. This division, 
which is to a demonstration real, because there are no other 
active or vital parts, except vessels and nerves in the body, is 
practically extremely convenient; since every person is 
aware that the chief difficulty in practice is to distinguish 
those diseases which are simply nervous, and which may 
continue for a long time without danger, and are often cured 
by stimulation or mild and feeble measures, from those 
actions of the vascular system which destroy the functions or 
structure of an organ, and which are for the most part 
curable only by agents promptly and vigorously put in 
force. 
The two divisions run into each other; the actions of the 
secreting organs, especially, are so intimately connected with 
functions of nerves, that it is scarcely possible to suppose 
any organ can have one of these elementary parts in a mor¬ 
bid state, without the other participating in it. The class of 
diseases, however, which are usually meant by the term 
vascular, are such as affect the red blood-vessels; for though 
these also are subservient to the action of the nervous sys¬ 
tem, the connection is not so intimate. No division of 
disease will be expected by the physiologist, to he marked 
with a precise line. The human body is a machine, every 
part whereof depends so closely on another, that an insulated 
action, and consequently an insulated disease, cannot take 
place. 
The function of a nerve in pathology is confined, 1st. To 
giving notice of the receipt of injury or other morbific cause 
to the mind ; in other words, suffering pain : this, however, 
is not invariable. 2dly. To causing an increased flow of 
blood to the inflamed part. 3dly. To exciting such remote 
actions of the system as may assist collaterally to the resto¬ 
ration of the part affected. Thus the action of the heart be¬ 
comes increased, the secretions of the digestive apparatus 
locked up, and other analogous changes take place in pro¬ 
portion to the severity of the primary disease. 
The reason why an injury should excite pain is very evi¬ 
dent. The utility of removing the injured part out of the 
sphere of the injuring cause, and of keeping it at rest, being 
apparent to any one. But why a blow should excite local 
inflammation, and also general fever, with a morbid change 
in the constitution of the whole mass of blood and in the 
action of all the animal organs, is so difficult of explanation, 
that what we shall proceed to offer can be looked upon as 
nothing more than conjecture. 
We shall do well to reflect that whatever injury may take place 
in the body, whether a contusion destroys the properties of a 
art, or an incision separates it, two things are necessary to 
e done. The dead part is to be removed, and the loss to be 
repaired by means of a new and similar structure. Both these 
changes take place through the medium of the blood. Info 
this fluid the old structure is to be absorbed; and from it the 
new one formed. Since these processes, though of the same 
nature, are greater in degree than the powers of the parts are 
wont to perform, it is necessary that these powers be increased. 
•In the first place, we should naturally expect that the quantity 
of blood should become greater. With this expectation the 
facts accord. There is obviously in inflamed limbs a greater 
quantity of blood than ordinary. But this blood requires to 
be changed, to be converted into the structure which is to be 
built up. Now, there can be little doubt that the assimilating 
power of blood-vessels is under the control of the nervous sys¬ 
tem ; and hence we see that extraordinary changes being re¬ 
quired, extraordinary nervous energies ought to be developed. 
Accordingly, increased heat and acute sensibility are mani¬ 
fested. 
Other and more general phenomena, however, take 
place, especially after serious injuries. A fever called sym¬ 
pathetic comes on. This fever consists in an increased action 
of the heart and lungs, exalted temperature of the skin, and 
diminution and alteration of all the secretions. The two' 
first of these phenomena being exactly of the same nature as 
what occurs in the limb itself, we may naturally refer them 
to the same purposes; namely, the increment in the quantity 
of blood sent through the limb, and of nervous power, in 
order to convert the blood into new structure. The dimi¬ 
nution of the secerning functions might be explained from a 
well known law of the nervous system ; namely, that if one 
portion of this system acts with unusual vigour, every other 
portion betrays unwonted langour. But it is probable that 
we should go deeper; that there is a second end answered by 
this tardiness of the secretions,—the alteration in the state of 
the blood. That this fluid is changed, is evident, since, in all 
inflammations it is what is called luffed ,—that is, inclined 
to separate coagulable lymph more rapidly, and in greater 
quantities than ordinary from the rest of its component parts. 
We have already so far anticipated what we had to say on 
the action of vessels in inflammation, as to state that the 
quantity of blood is increased in a limb when it is inflamed; 
this being a point easily solved by experiment, and allowed on 
all hands. Authors, however, are divided as to the question 
whether the blood moves slower or faster than ordinary in 
inflamed vessels. Doctors Hastings, Wilson Philip, and 
others, conclude, from microscopical observations, that the 
current of the blood is retarded in velocity, but that the ca¬ 
libre of the vessels is enlarged. But the inaccuracy of this 
opinion is proved by a process of reasoning far less liable to 
inaccuracy than observations made with the microscope. 
There is no fact more obvious than that the arteries going to 
an inflamed part, are larger than ordinary. But supposing 
there were in the part which they are passing any impedi¬ 
ment to the flow of blood, would they enlarge ? On the 
contrary ; no law is more clearly established than that arte¬ 
ries contract whenever a resistance is offered to the exit of 
their blood. A ligature around an artery causes this pheno¬ 
menon to take place at once. Pressure causes the same thing, 
though 
