Onésime Delafond (1805-1861) and the doctrines of pathology. Part 3. The doctrines of solidism and vitalism according to Broussais and the emancipation of veterinary medicine

The last concept of disease, presented by Delafond to his readers in 1838 is, what was called in his time the doctrine physiologique, or Broussaisisme.

Jean-Joseph-Victor Broussais (1772-1838) was a medical doctor with, initially, a controversial reputation because of his resistance to the medical opinions of Pinel and Laënnec, the anatomico-pathologsts of his days, and because of his proposals for a physiological approach of disease. However, after some time his concept of medical physiology was broadly accepted and became the most popular of all medical doctrines; this was among others due to his oratorical talents. In this doctrine disease may occur when normal functions fail and most, if not all, diseases are the result of the irritation and subsequent inflammation of the gastrointestinal tract. Broussais was an ardent believer in bloodletting by leeches and millions of leeches were applied for that purpose in France each year. (1)
 

Jean-Joseph-Victor Broussais (1772-1838)

This is what Delafond has to tell us about Broussais' theories.

He starts his discussion by stating that Broussais took various ideas from others, Brown and Pinel among them, and from the physologists like Bichat and Magendie, to combine it in a new but controversial concept of the physiological doctrine (why it was controversial will be become clear below). Delafond describes the basis of this doctrine in eleven propositions, of which I will take a few in an effort to summarize Delafond who tries to summarize Broussais.

* Diseases are the result of an alteration in the solids, but some may have their seat in the humors.

* All diseases start with irritation and initially they are local, that is, organ bound.

* By natural sympathy the suffering of organs is transmitted to other organs at a distance.

* The brain perceives all sympathies and redistributes them over the organs.

* The mucous intestinal membranes take the first place in the distribution of the irritation; all irritations have their effect on stomach and intestines.

* Eighty percent of all dieases are irritations of the intestinal mucous membranes, or are cases of gastroenteritis. The action of all exciting causes, external or internal, be it toxins, viruses (in the 19^th century sense; BN), etc. is directed at the gastrointestinal system.

* All therapies (diet, blood letting, cooling agents, rest, etc.) have to be applied to manipulate the irritability of the stomach and intestines. Knowledge of gastroenteritis is the key to pathology.

It is at this point that Delafond starts to reflect on what use this doctrine may have for veterinary medicine.

The principles of the doctrines of Broussais were simple and the number of curative agents were limited, which made it attractive and led to a a multitude of followers. Soon medical doctors were seen adopting tha bases of the doctrine and praising their application for wonderful results, also in the diseases of animals. But, according to Delafond, the doctrine was undermined by anatomical-pathological studies and never received a moment of fame in veterinary medicine. The autopsies of bodies immediately after death showed that not all diseases were characterized by gastro-intestinal irritations and that certainly less than the estimated 80 % contained inflammations of the intestines. Anti-phlogistic remedies proved ineffective in quite a number of horses, cattle and sheep. Many veterinary practitioners maintain the principles of Broussaisism for congestions and real inflammations but refute them for a great deal of other diseases. In other words: Since twenty years veterinary medicine has liberated itself from the patronage of human medicine.

Delafond feels proud that veterinarians have made use of and still use a medicine of observation. They are partisans of a medical eclectisism that never will adopt one of the medical doctrines exclusively. Delafond describes the different strategies that are derived from these doctrines, without preference for one above the others: we studied diseases in their known causes; we collected with utmost care the pathognomonic (i.e. the distinctive characteristic) symptoms that signaled the diseases in their disordered functions as well as in the state of the solids and the liquids; we raised the flame of pathologic physiology to enlighten us in the exploration of their manifestations; we studied the morbid alterations visible after death, both in liquids and in solids, to discover the nature of their seat; finally, our indications for cure are deduced from the symptoms, the causes, the nature and the seat of the disease. See here our methods to study diseases. We take from the doctrines, described before, what is useful and makes sense, because they all have their advantages and inconveniences.

Delafond concludes that a reasonable medicine, the daughter of observation and experience (and in contrast to a medicine based on theories; BN) is the only medicine that should guide the veterinarian in the study of the pathology and therapies of diseases of domestic animals.

It is no use to search for the intimate nature or the essence of disease, or for the unknown morbid action that goes between the cause and onset of the disease and its appearance: let us concentrate on palpable, material and sensible effects. Because this morbid action is a secret that nature has covered with an impenetrable veil that man has not been able to lift and will never do so.

1. More about Broussais: E.H.Ackerknecht 'Broussais, or A Forgotten Medical Revolution' Bulletin of the History of Medicine, (1953) 27,  320

Onésime Delafond (1805-1861) and the doctrines of pathology. Part 2.

The doctrines of solidism and vitalism: Brown, Razori and Pinel.

Delafond opens his overview of solidism and vitalism with a description of the ideas of Themison, 1^st century BC, a member of the methodist school that concentrated on treatments of disease rather than on treatment of individual patients. The methodist doctrine dominated the medical practice in the Roman empire for three centuries. Themison established, according to Delafond, the principle in which the fibres, which constituted the organs, were present in two states, tension (strictum) or relaxation (laxum). The fibres are the solid parts of the body: nerves, muscles, etc. Tension of the fibres is connected to their sensibility and relaxation to their debility or weakness. An excess of one of the two determined the diseases.

These ideas were later, in the 18^th century, elaborated and joined with ideas about vital properties derived from the anatomical and physiological findings of Haller and, eventually, raised, enlarged and fortified into a doctrine of solidism in which diseases have their seats in solid organs.

The solidists agree that the organism has a vital property called sensibiblity (excitability, irritability) which belongs to the solid parts exclusively. The sensibility is in equilibrium with the impressionability; this equilibrium may be disturbed by morbid agents and disease will then originate in the solids. In the course of the disease the circulating liquids play a passive role; if they are altered it is a consequence of alterations of solids.

Before I continue with Delafond's discussion of the ideas of four solidists I want to remark that, when looked at it in more detail, the doctrine of solidism is much more complex than described by Delafond, but, on the other hand, he wanted to treat the subject in not more than half a page. It is also important to realise that much of the ideas of solidism were developed shortly before or even during his own lifetime, and he may have tried to find an easy way to inform his readers about how to deal with recent and sometimes controversial opinions about animal disease.

After explaining solidism Delafond gives a review of the four great doctrines that are based on solidism and vitalism, because he wants to investigate the influence these may have had on veterinary medicine. These doctrines are named after the persons who proposed them: Brownism, Razorism, Pinelism and Broussaisism. I will treat here the first three, and will postpone the discussion of the ideas of Broussais to the next blogpost.

Brownism, or the doctrine of the Scottish doctor John Brown, (nowadays called the "Brunonian doctrine of medicine") is, according to Delafond, the idea that life is maintained by stimulants. They may exert an impression by excitability (the capacity of being brought into a reaction upon a stimulus) or incitability (the aptitude to be stimulated) of the fibers. In my view both ex-and incitability are more or less the same, but in the opinions of 19^th century they were different. Stimulants may be internal (nervous influx; excersising function; muscular activity) or external (external bodies, either weightless or with some weight; solids, liquids; gases). These stimulants may be general or local. Life and health may be dependent on the stimulants. Too much stimulants result in sthenic diseases, too little stimulants give asthenic diseases.

The Scottish doctor John Brown (1735-1788)

Delafond goes on describing the various details of the Brownian doctrine, but we may omit them without problems, because his own conclusion is that it may be an attractive theory but that it is difficult to apply in practice. It has numerous followers in medical and veterinary Germany and Italy, but has been neglected in England and France; Delafond states that he does not know a single veterinarian in France who had adopted or tried to propagate the Brownian doctrine.

Razorism, is the doctrine of the Italian medical doctor Razori (of whom I had never heard before). According to Delafond, Razori should be remembered because of his practical approach of the principles of Brown. He tried to find agents that might reduce the excess of incitation that causes sthenic diseases; he called those counter-stimulants. These agents, chemical or physical, had a special power with a sedative capacity with which sthenic diseases could be cured. Some of these counter-stimulants could be used for certain categories of disease: purgatives, emetics, cold and, especially, blood-letting. In the same sense Razori argued that asthenic diseases may be due to an excess of counter-stimulants and he tried therefore to find agents capable of restoring the excitability; these he called stimulants. Among them we may find alcohols, tonics and opium.

According to Delafond, Razorism connects Brownism (emphasis on fibers) with vitalism (emphasis on (counter)-stimulants). He deplores the neglect Razori and his followers showed for insights from anatomy and physiology that led them to several erroneous theories, but he praises them for their empirical skills which brought them to the therapeutic applications of the large dose of emetics as a counter-stimulant in the beginning of certain diseases that gives such uncontested cures.

Pinelism, a doctrine developed by the French doctor Pinel, famous for his absurdly detailed disease classification, (but nowadays considered the founder of modern psychiatry) is only shortly discussed by Delafond.

Philippe Pinel (1745-1826),

 Pinel, Delafond tells us, made a bizar mixture of Brownism, humourism, vitalism and solidism, which is easily seen when you open his book of Nosographie Philosophique and read about his essential fevers, the phlegmasies, the neuroses and active and passive hemorrhages. In Pinel's doctrine vitalism may be seen as predominant in this doctrine; nature is transformed or perverted, and therefore needs the medical doctor to be saved.

Pinelism had not much impact in veterinary medicine, is Delafond's conclusion, at least less than in human medicine; a few professors taught it in schools, but it was soon abandoned by the veterinary profession.

Onésime Delafond (1805-1861) and the doctrines of pathology 1.

Part 1. Humorism

Henri Mamert Onésime Delafond was one of the more important veterinarians of 19^th century France. He obtained within a few years after his graduation as a vet a chair in pathology and therapeutics at Alfort and during almost his whole professional life he was a member of the board of the Receuil de Médecine Vétérinaire, in which he frequently published. In 1860 he was appointed director of the Veterinary School of Alfort, but he died, too early, soon after.(1)

In this blogpost and the next I want to present an overview of his ideas about the doctrines of pathology, taken from his book Traité de Pathologie Vétérinaire, published in 1838. (2) For several reasons this is an interesting chapter in his book. First, it is a description of the principles of pathology by an expert who himself made active use of these principles in his teachings and veterinary practice; the knowledge we have been taught of these doctrines is most of the time presented by historians of medicine who have never lived in the middele of them. Second, Delafond presents a short history of the way these doctrines have been modified, adapted and received, and gives comments on them, as a person who has contributed to their use in veterinary practice.

Paragraph 5 of the first chapter of this book (p 24-24) then is devoted to the nature and seat of disease and the doctrines of pathology. The discussion concerns of course the doctrines that were current in his time. The principles of pathology as given by Hippocrates and Galen were slowly mingled with, or replaced by, new ideas. Delafond treats them in a clear way, indicating their strenght and weakness, and suggests how a veterinarian in the third decennium of the 19^th century may use them for his own benefit.

Delafond states that ever since learned men have tried to find what constitutes the essence, or the inner nature (nature intime) of diseases, that is, whether it is the liquids or the solids that are altered. Those who adhered to the principle that the humors (the liquids) were the first seat of disease have only tried to remedy the alterations of the liquids. The others have only seen alterations of the solids and have tried to cure accordingly. These opinions, collected in systems, have received the name of medical doctrines. Delafond promises us that we are going to learn which of the current doctrines are in vogue and which has the most adherents. Not unexpectedly, he distinguishes two categories of doctrines, the humorism, or doctrine humoral, and solidism and vitalism.

Here I want to summarize Delafond's description of humorism; I will write about his solidism and vitalism in a subsequent blogpost.

Humorism is the Hippocratic doctrine that attributes all diseases to something that is wrong in the body fluids. Delafond is rather short about it. The body fluids, the humors, are the well known blood, phlegm (slime), yellow bile and black bile. Diseases are related to a deficiency, overabundance or a disproportion of these humors. The repair of the equilibrium of humors that reigned between them is the recovery of health. The other main theme in the doctrines of Hippocrates is, according to Delafond, the idea of the three periods in the diseases of the humors. They are: crudity, coction and crisis. In the period of crudity the morbific element is present in its most forceful form; in the period of coction this element either causes death or it recedes under the influence of nature; in the period of crisis it is driven out of the economy of the body. Therapy consists of observing the progress of disease and modify it in a way that accords with each of the three periods.  Observation is the main characteristic of Hippocratism.

Next Delafond gives a short overview of all kinds of different doctrines that grew out of the Hippocratic doctrine; dogmatic and ecletic theories giving rise to ideas that lost sight of the old Hippocratic tradition until the latter was restored more or less by the empirism that rested on observation, history and analogy. But other theoreticians appeared on the stage who were trained in chemistry and physics and added their expertise to the humoral doctrine. They were interested in the chemical and physical properties of fluids; these could be more condense or more fluid, acid or alkaline or acrimonious which were properties that could be treated therapeutically. A humoral physiological pathology developed, in which symptoms like a violent pulse and the force of the heartbeat were due to tension of the humors and in which changes in the color of the urine and its consistency such as sediments and stones were the consequence of the expulsion of altered urine.

Delafond enumerates many examples of changes in properties of blood or lymph and accumulations of liquids that the body cannot get rid of, or, in Hippocratic terms, that the crisis could not expulsate. All changes are due to liquids that are modified by heat, cold, bad digestions, influence of poisons and morbific elements in the air. All therapies are aiming at restoring the old situation of balance in each of the three periods of disease progress.

In the end of his overview of the Hippocratic doctrine Delafond sums up the Greek, Roman and French hippiatrics (horse vets) and founders of the French veterinary school "who adopted the doctrines brought forward by the humorists thereby making a bizar mixture of the Hippocratic doctrine and the explications of the great humorists Galen and Boerrhave [sic]". But yet, he states (relieved, it seems), one may find in the later writings of Bourgelat and in all the works of Chabert an autocracy (unlimited reign) of nature united with vitalism and the strictum and laxum of the solidists.

1. Source of biographical details and portrait:  Neumann, Louis George. Biographies vétérinaires, avec 42 portraits dessinés par l'auteur. Paris, 1896. p 86

2. O.Delafond, Traité de Pathologie et de Thérapeutique Générales Vétérinaires, Bruxelles, 1838.