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DISEASES OF MAN:



DATA OF THEIR



NOMENCLA TURK, CLASSIFICA TION &^ GENESIS.



To DESCRIBE IS TO PARTICULARISE.

" Words are the fortresses of thought."
" In words are contained the sciences possessed by the
nations of the earth. ..."

To DEFINE IS TO GENERALISE.

Definition is the summary of description.
" Perfect definition is the summit of human knowledge in
every part of science "

"To NAME IS TO KNOW."

" The true progress of science must always be realised in
names."

"Things are known when understood and are understood
when interpreted."

"The perfection of a science depends, in no inconsiderable
degree, upon the perfection of its language; and the perfec-
tion of every language upon its simplicity and precision."

"To THINK IS TO CLASSIFY,"

and to classify is to think.

" System is the Ariadnean thread without which all is con-
fusion."

" Classification is not attainable by art only, it requires a
mind that is capable of distinguishing things by their specific
differences ; not separating things that are alike nor blending
things that are different."



DISEASES OF MAN:



DATA OF THEIR



NOMENCLATURE, CLASSIFICATION &<» GENESIS.



BY



JOHJST ^Sr. S. G^OUILi:E Y, M. D.,

Surgeon to Bellevue Hospital.



NEW YORK :
J. H. Vail & Co., 2 1 Astor Place.

LONDON:

H. K. Lewis, 136 Gower Street.

1888.



Copyright, 1888.
By J. W. S. Gouley.



PREFACE.

The objects of this book are ; first, to urge the
official adoption of a stable basis for the nomen.
clature and classification of the diseases of man ;
second, to place before the medical profession
certain propositions directed to an improved
classification of diseases ; and third, to awaken
the attention of teachers to the necessity of
ameliorating the nomenclature of medicine,
pointing out some of the many misused and im-
properly formed words that are now current,
and proposing new terms for their considera-
tion.



6 PREFACE.

In attempting to classify the affections of the
male urogenital apparatus, it was found diffi-
cult to do so satisfactorily, owing to the defects
of the existing nomenclature. This led to an
inquiry into the former and actual state of nos-
onomy and nosotaxy, and into the methods em-
ployed by nosographers from the time of
Sauvages to the present. The conclusion ar-
rived at, is that a nomenclature and classification
to be useful and stable should not only rest
upon a proper foundation, but should be duly
authorised by the whole profession of medicine.
The principles deduced from an analysis of the
methods of nomenclators and classifiers are now
submitted to the profession ; and certain ques-
tions are suggested for discussion in, and for
settlement by, the International Medical Congress
which properly represents the medical profes-
sion.

The presentation of this subject to the profes-
sion is designed as a plea for the more systematic



PREFACE. 7

study of diseases, and as an individual protest
against their existing nomenclature and classfica-
tion, with the hope that this protest will become
general among teachers and others who realise
the necessity of bettering the condition of
medicine, without undertaking to destroy its
fabric in order to reconstruct it ; but rather to
modify, simplify, and improve it by gradually
substituting exact terms for those that have
never conveyed correct ideas.

During the preparation of this book, more
or less frequent consultations were held with
Doctors Clymer, Carroll, Flint, Biggs, Cronyn,
Taylor, Clark, Leale, Grauer, John Shrady,
Edmund Arnold, and others. The valuable sug-
gestions of these kind friends are gratefully
acknowledged.

Botanists, Mineralogists, Biochemists and Phi-
lologists have been consulted with much advant-
age and their hints have been thankfully received
and carried out.



8 PREFACE.

Works on Botany, Zoology, General Chemis"
try, Biochemistry, Physiology, Descriptive Anat-
omy, General and Special Pathology, and Sur-
gery, and many of the treatises on nomenclature
and classification have been freely used. A
general acknowledgment is made to the authors
of these works which have been of the greatest
service in this endeavor to elucidate the princi-
ples of nosonomy and nosotaxy.

324 Madison Avenue,
New-York, January 1888.



CONTENTS.

PREFACE, page 5-8

CORRIGENDA, " I2

INTRODUCTION "13-24

SECTION I.

Preliminary Considerations.

Outline of the anatomical view of man. Definition of med-
icine. A classification of the science and art of medicine.
Medicine and Surgery. Arrangement of medicine into certain
departments in accordance with the apparatuses of the humaa
body. The physician. Definition of disease. A synopsis of
the morbid states and morbific processes of the body. The
value and significance of proper anatomical terms in classi-
fication. Definition of system, organ, apparatus, and function.
Systems and organs perform no function, but yield service to
apparatuses. Each apparatus performs only one function,
and there is no function without an apparatus, . page 25-72



lO CONTENTS.

SECTION II.

Human Nosography.

A summary of the progress of nosography since its founda-
tion. The scope of nosography. Notice of Sauvages. A
consense of views necessary in methodical arrangement.
Synopses of Sauvages'. Cullen's, Parr's, Good's, and Delorme's
arrangements of diseases. Comments on these several sys-
tems. Cullen's rules for distinguishing genera, species, and
varieties of diseases. Parr's rules. Some of the aphorisms,
relating to classification, extracted principally from the phil-
osophia botanica of Lmnaeus, by Dr. Thomas Young,

page 73-199

SECTION III.

NOSOGRAPHICAL BIBLIOGRAPHY.

A chronological list of the works on nosography that have
appeared from the time of Felix Platerus to the present,

page 200-2 1 1

SECTION IV.

Basis and Method of the Classification and

Character of the Nomenclature of

THE Diseases of Man.

Many high authorities opposed to classification. To think
is to classify. Characteristics of good classifiers. Modem
classifiers use terms of classification arbitrarily without taking
the pains to define these terms. Nosography on the basis of
symptoms misleading and retrogressive. Anatomy the only
stable basis for nosography. Description and definition of dis-



CONTENTS. II

eases. Methods of the nosographer. The use of the dead
languages in nomenclature. The names of men should not
be applied to diseases. Suggestions for an improved classifi-
cation of diseases. A consense of views necessary in the use
of terms of classification. Questions suggested for discussion
at the Tenth International Medical Congress. Definitions of
the terms of classification page 212-252

SECTION V.

Review of the Morbid States and Morbific

Processes. The Bacteria. Ptomaines,

Leucomaines, and Extractives.

Analysis of some of the terms used in general pathology
and of those contained in the synopsis of morbid states and
morbific processes, together with remarks on these states and
processes. Summary of the present state of knowledge of
the bacteria, ptomaines, leucomaines, and " extractives."
The relations borne, to medicine and surgery, by these micro-
organisms and alkaloids of putridity. Classifications of the
bacteria, ptomaines, and leucomaines. Uniformity in their
nomenclature and classification much needed. Remarks on
the neoplasams and on their classification, - page 253-379

CONCLUSIONS " 380



CORRIGENDA

Page 36, second line, for propylactic, read prophylactic.

40, foot note, for celibary, read celibacy.

48, V. 8, for (obsteoma), read (osteoma).

56, foot note, for eyyEvrjiy read EyyEviji.

63, " " for opyavov, read opyavov.

67, tenth line, for antonomous, read autonomous.

69, fifth line from bottom, for corect, read correct.
102, IX. L, for sangninfluxus, read sanguifiuxus.
150, fourth line, for cornea, read cornea.
212, first line, for authorites, read authorities.
255, foot note, for t'ltoy read V7t6.

365, third line from bottom, for oDoii, read aodii.
For Laenec read Laennec.



13
INTRODUCTION.



I. This book is divided into five sections. The
first section comprises : some anatomical consid-
erations of the normal human body; a statement
of the objects and scope of medicine ; a classifica-
tion of medicine ; the mutual relations of medi-
cine and surgery ; an arrangement of medicine
into departments in accordance with the appara-
tuses of the human body ; the definition and
genesis of disease ; a synopsis of the morbid
states and morbific processes of the body, de-
signed as a suggestion of a ground-work for the
classification of diseases; and an analysis of some
of the anatomical terms used in classification.
The synopsis of morbid states and morbific pro-
cesses stops at genera, but a few species are given
in foot-notes.

The second section relates to the history, de-
velopment, scope and significance of human
nosography, and contains synopses of a considera-
ble number of systematic arrangements of dis-
eases, illustrative of the principles of nomencla-
ture and classification, and also rules for the
guidance of nosographers by Cullen, Parr, Young
and Linnaeus.



14 INTRODUCTION.

The third section consists of a nosographical
bibliography, chronologically arranged, from the
time of Felix Platerus.

The fourth section is devoted to the elucida-
tion of what is conceived to be a proper basis,
character, and method of the nomenclature and
classification of the diseases of man : and to the
definitions of the terms of classification.

The fifth section is intended as further explana-
tions of the morbid states and morbific processes,
and as an analysis of some of the terms used in
general pathology, besides which it embodies a
summary of the present state of knowledge of
the bacteria, ptomaines, ieucomaines, and " ex-
tractives," and indicates the relations borne, to
medicine and surgery, by these microorganisms
and toxic alkaloids of putridity, and finally re-
marks on the neoplasms and on their classifica-
tion.

2. This work is undertaken with the hope that
it will induce all those devoted laborers in the
field of medical science who are struggling so
diligently to solve great problems in physiology,
histology, pathoanatomy, and therapy, to con-
sider how much assistance methodical arrange-
ment will afford them in their investigations and
how much of their time will thereby be saved J



INTRODUCTION. 1 5-

also how important it will be for them to adopt a
correct and uniform nomenclature. They will
then probably reject all inexact terms and coin
words, — ** verba-fidelia " — in accordance with the
conditions they wish to designate with precision.

In medicine, the coinage of a new word is at»
tended with some difficulty and requires much
deliberation, besides the censorship of men of ex-
perience and sound judgment. The word should
then be submitted to the profession, whose ver-
dict on the question of its general adoption
should be respected. On this subject of the coin-
age of words, Ben Jonson says : " A man coins
not a new word without some peril, and less
fruit ; for if it happen to be received, the praise
is but moderate ; if refused the scorn is assured."

At present, a very considerable part of the
nomenclature of medicine consists of such a great
number of inappropriate, incorrectly formed and
misleading terms, that often it is not easy, for
investigators, even of the same nation, writing in
the same tongue, to understand each other.

" It is a waste of time," says Mill, in his Exam-
ifzation of Sir William Hamilton s Philosophy, " for
a mere student of philosophy to have to learn
the familiar use of fifty philosophic phrase-
ologies." This applies with much force to the
many anatomists and medical investigators who



l6 INTRODUCTION.

use words of their own invention which others
are at great pains to understand.

3. While the progress made in medical art
during the last quarter of a century is marvelous,
the improvement in the nomenclature has by no
means kept pace with this great advance in the
art of medicine. Accuracy is often attained in the
latter while it seldom obtains in the former. If
more attention were given to the formation of
scientific language, much confusion and misap-
prehension, which have the effect to impede the
progress of medical science, would be avoided.

The technical terms of medicine derived from
the Latin and Greek tongues are used partly for
the sake of brevity and partly that they may be
understood by the medical profession of the dif-
ferent nations that cultivate the dead languages.
Unfortunately hovvever the cultivation of these
languages is too limited among physicians. As a
consequence, many meaningless expressions and
as many hybrid words, compounded of Latin and
Greek and sometimes of Hebrew roots, very dis-
tasteful to the experienced scholar and serving to
puzzle rather than to instruct the junior student,
are constantly used in text-books and other
works. The few modern writers who have un-
dertaken the task of improving the nomenclature



INTRODUCTION. 1 7

of medicine are little heeded, and professors in
the great schools are still thoughtlessly dissem-
inating false notions by the careless use of inac-
curate expressions in their daily lectures. Many
ancient words, however inexact and absurd, are
adhered to with great tenacity, and innovations
the most appropriate are resisted with an ob-
stinacy too little in keeping with the forward
movement of the time. Conservatism is praise-
worthy Avhen applied to words that have stood
the test of years and are still adjudged good and
proper, Those time-honored terms v/hich convey
ideas with precision should be jealously pre-
served ; but that multitude of misleading expres-
sions, to be found in the literature of medicine,
should be speedily blotted out of coming medical
treatises and dictionaries, and their places filled
with well chosen and philologically correct
words.

If teachers in the several departments of medi-
cine will earnestly consider this subject, and if
each will contribute his share to the reformation,
in another quarter of a century there will surely
be a more uniform and exact medical language.

The needed reformation in medical nomencla-
ture should however be rightly directed, and
those who undertake it should be mindful of
Lord Bacon's precept that " It is good also, not



I8 INTRODUCTION.

to try experiments ; except the necessity

be urgent, or the utility evident : and well to
beware that it be the reformation that draweth
on the change ; and not the desire of change
that pretendeth the reformation."

4. It is improbable that the often repeated
statement, " it is not profitable to attempt to
change the present methods of writing and of
teaching medicine owing to its great mutability,*^
will deter nomenclators and classifiers from the
pursuance of their investigations, but it is a fact
that they are too little encouraged, even by those
who realise the necessity of a radical change in
these methods. Exact nosonomy and nosotaxy
will surely cause greater changes and advances
than have ever been made in medicine. To give
correct names to diseases involves the closest in-
quiry into their nature. It is therefore fair to
assume that the time will come when the name
given to each disease shall indicate its nature.
When this good time does come, medicine will
be taught as other sciences are taught. The con-
sideration of the advances destined to be made
by a methodical nosography, leads to the conclu-
sion that it must keep pace with the advancement
to which it has given rise, and must of necessity
be provisional.



INTRODUCTION. 1 9

5. The inexact nomenclature of diseases, and
the defective arrangement and inconsistencies in
existing S3'stems are such that it is almost im^
possible for the student to learn medicine as he
should ; and, in view of its continued advances,
this will be quite impossible in a quarter of a
century, unless a radical change be made first in
the nomenclature of anatomy and next in the
nomenclature and classification of diseases.

Without an accurate nomenclature and classi-
fication, the one hundred and tvv^enty thousand
flowering plants could not have been known, nor
could the immense number of species of animals
be studied, and it would not have been possible
to obtain an accurate knowledge of minerals.
Thus Botany, Zoology, and Mineralogy, have for
many years, taken each a high rank among the
sciences owing to proper nomenclature and to
methodical arrangement.

The science of medicine will never progress as
it should and will never be learned as it should
be learned until it is placed upon the same foot-
ing as that of the natural sciences.

Without an accurate nomenclature and classi-
fication it is very difficult for the practising phy-
sician to have the clear understandmg of diseases
so necessary to their rational treatment. All
morbid states of the human body should be



20 INTRODUCTION.

known by names that indicate their nature, and
it is only a right conception of this nature which
can lead to the use of appropriate remedies.

6. The terras nomenclature and classiiication of
diseases do not by themselves express with suf-
ficient precision the scope and objects of syste-
matic arrangement. Therefore the word nosog-
raphy should, in its broadest sense, be employed
to signify the whole, or some part of the science
of medicine as, for example, human nosography,
nosography of the uro-genital apparatus, or of
any other apparatus of the human body.

7. It is often said that language fails to express
with accuracy the ideas which man conceives of
things. Sweepmg as this statement may seem, it
is defensible, particularly in the case of medical
language which so much needs reconstruction.
That however which causes the greatest per-
plexity in the expression of ideas, is the misap-
plication of words, and also their employment in
different senses, so as to give to each several
meanings. Since it is not probable — at least not
for a very long time — , that human language will
consist of words having each a single meaning,
the most judicious use should be made of existing
terms and the greatest care taken in the forma-
tion of new words ; and all writers should strive



INTRODUCTION. 21

to give a clear exposition of their ideas by some-
times explaining the words of many meanings
which they are obliged to employ. Some of the
great faults in medical language are : (i,) the
misapplication of words; (2,) the use of improp-
erly constructed words; (3,) the use of words
which do not convey an exact idea of the object
designated ; and (4,) the use of men's names to
designate diseases. These faults are all remedia-
ble, but to repair them most effectually and to
prevent their recurrence, a consense of views in
the medical profession is absolutely necessary ;
then the changes in terms will be uniform, will
come authoritatively, and will therefore be ac-
cepted.

It appears that medicine is not the only science
whose progress has been hindered by abuses in
terms.

In his Elements of the Philosophy of the Human
Mind, Dugald Stewart says : " When I consult
Johnson's Dictionary, I find many words of which
he has enumerated forty, fifty, or even sixty dif-
ferent significations ; and, after all the pains he
has taken to distinguish these from each other, I
am frequently at a loss how to avail myself of his
definitions."

A great thinker and metaphysician comments^



22 INTRODUCTION.

-as follows, upon words and deplores their wrong
usage.

" In words are contained the knowledge

and sciences possessed by the nations of the

earth A strict adherence to propriety in

the use of words, is the only means for maintain-
ing clearness of ideas, for preserving and har-
monising them Many ancient and modern

sophists, and many profane philosophers, sought
artfully to alter the true value and force of
words. The world could scarcely be deceived
except by such alteration. Abuse has been made
of almost all philosophical and political terms, as
has been frequently shown by various writers.
Whoever takes note of the errors that have arisen
from the abuse of the word Nature, in the
sciences of Right and Politics — of the words
Sensation, Pleasure, Pain, in Metaphysics ; of the
words Equality and Liberty in Politics; of the
word Wealth in Political Economy — and of the
many others to which, generally, there has been
added only a more extensive signification than
that given them by common usage, will discover
the sources of incredible deceptions to the mind,
and of incredible evils to humanity." (Rosmini^
Introduzione alia Filosojia.)

Max Miiller in his Science of Thought ^ 1887, (p.
18) says :,.....*' That every one of these words



INTRODUCTION. 23

is used in different senses by different philoso-
phers, might be tolerated, if each philosopher
would tell us clearly, and once for all, in what
sense he himself means to use them. This is
what few attempt to do ; and if they do it, they
often seem to imagine that because there are so
many words, there must be also so many distmc-
tions. They overburden us with definitions and
make confusion worse confounded."

The following, which is much to the purpose
is also quoted from the recent work of Max
Miiller.

" All I maintain is that, not only to a considera-
ble extent, but always and altogether, we think
by means of names, and that things are no more
to us than what we mean by their names. What
we really mean by names must be settled by defi-
nition, and according as our knowledge changes,
the definition and therefore the meaning of names
will change. Every new addition to our ex-
perience may be said to change, to correct, or to
complete the intension and the extension of our
names, but before we can use our new knowledge,
it must always have been embodied either in an

old or a new name There may be little or

much, there may be false or true knowledge in
our names, but without some sort of name we
cannot reason," (p. 35, Science of Thought,)



24 INTRODUCTION.

8. As a means to the desired end, students of
medicine should be thoroughly drilled in the use
of words of precision, whose employment is
coupled with exact knowledge, — not forgetting
the fact that to name is to know^ for these two
words have been traced to the same root whose
antiquity is almost as great as that of man — , and
exact medical knowledge, methodically arranged,
will inevitably lead to its practical application in
the cure of disease or the alleviation of human
suffering. High as is the achievement of curing
disease or of alleviating suffering, the physician
should aspire to the still higher object of preserv-
ing the health of the people. This should be the
end of medicine.



•^



PRINCIPLES

OF

NOMEiXCLATURE AND CLASSIFICATION.



SECTION I.

Preliminary Considerations.

Outline of the anatomical view of man. Definition of medi-
cine. A classification of the science and art of medicine.
Medicine and Surgery. Arrangement of medicine into certain
departments in accordance with the apparatuses of the human
body. The physician. Definition of disease. A synopsis of
the morbid states and morbific processes of the body. The
value and significance of proper anatomical terms in classifi-
cation. Definition of system, organ, apparatus, and function.
Systems and organs perform no function, but yield service to
apparatuses. Each apparatus performs only one function,
and there is no function without an apparatus.

THE HUMAN BODY.

Anatomically considered man's body is a
grand complex apparatus destined to perform
the one function of reproduction of its species.
To that end the male and female must couple.
The sperm of the male then fecundates the ovum



26 THE HUMAN BODY.

which is within the female, and she completes
the function of reproduction of the species.

This primary human apparatus is an assem-
blage of secondary apparatuses that are intended
to perform certain special functions, some of
which are designed to conserve the individual,
and others to keep the body in a healthy condi-
tion and fit it for the performance of its one great
function.

The senses of man, each of which being the
function of a special apparatus, are all subservi-