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)
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| 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 19th
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
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